Responsiveness to inhaled corticosteroid treatment in patients with asthma-chronic obstructive pulmonary disease overlap syndrome

Ann Allergy Asthma Immunol. 2014 Dec;113(6):652-7. doi: 10.1016/j.anai.2014.08.021. Epub 2014 Oct 3.

Abstract

Background: Inhaled corticosteroid (ICS) is recommended in the management of patients with asthma-chronic obstructive pulmonary disease overlap syndrome (ACOS), but its effectiveness has not been clearly proved.

Objective: To evaluate whether ICS has effects on outcomes of ACOS.

Methods: In this observational 12-year retrospective cohort study involving 125 patients with ACOS from Seoul National University Hospital, the annual rate of decrease in forced expiration volume in 1 second, the incidence rate of severe exacerbation, and overall mortality in an ICS-treated group were compared with those in a non-ICS-treated group.

Results: Of 125 patients with ACOS, 90 and 35 were categorized to the ICS and non-ICS treatment groups, respectively. There were no significant differences between the 2 groups in the annual rate of decrease in forced expiration volume in 1 second (9.61 mL/year in ICS treatment group vs 15.68 mL/year in non-ICS treatment group, P = .598). Compared with the non-ICS treatment group, the ICS treatment group did not show a decrease in the risk of severe exacerbation (adjusted incidence rate ratio 1.24, 95% confidence interval 0.44-3.46). Time to death also did not differ between the 2 groups. Even when analyses with propensity score matching were performed, the results were similar.

Conclusion: In the management of ACOS, the use of ICS was not significantly associated with improvements in the annual rate of decrease in forced expiration volume in 1 second, the incidence of severe exacerbations, and overall mortality compared with the non-ICS treatment group.

Publication types

  • Observational Study

MeSH terms

  • Administration, Inhalation
  • Adrenal Cortex Hormones / therapeutic use*
  • Adrenergic beta-2 Receptor Agonists / therapeutic use
  • Aged
  • Asthma / complications
  • Asthma / drug therapy*
  • Asthma / mortality
  • Asthma / physiopathology
  • Bronchodilator Agents / therapeutic use*
  • Drug Therapy, Combination
  • Female
  • Forced Expiratory Volume
  • Humans
  • Male
  • Middle Aged
  • Muscarinic Antagonists / therapeutic use*
  • Pulmonary Disease, Chronic Obstructive / complications
  • Pulmonary Disease, Chronic Obstructive / drug therapy*
  • Pulmonary Disease, Chronic Obstructive / mortality
  • Pulmonary Disease, Chronic Obstructive / physiopathology
  • Republic of Korea
  • Retrospective Studies
  • Severity of Illness Index
  • Survival Analysis
  • Treatment Outcome

Substances

  • Adrenal Cortex Hormones
  • Adrenergic beta-2 Receptor Agonists
  • Bronchodilator Agents
  • Muscarinic Antagonists