Chronic obstructive pulmonary disease (COPD) is a common lung disease causing restricted airflow and breathing problems. Patients with this disease have occasions when their symptoms suddenly worsen, which called flare-ups or exacerbations. Doctors may prescribe oral corticosteroids (a course of steroid tablets, OCS for short) to manage these flare-ups. Patients may be also provided with “rescue packs” containing OCS and antibiotics to be kept at home and used when necessary.
According to the findings presented at the 2021 British Thoracic Society Winter Meeting, systemic corticosteroid prescriptions for patients with COPD increased from 5.8% in 1990 to 34.8% in 2017. While OCS may speed up recovery from flare-ups, its repeated use may have negative health effects, yet the potential short- and long-term risks associated with OCS use have not been well understood for patients with COPD. Given the increasing and common intermittent use of OCS for patients with COPD, an analysis of intermittent OCS use over a long-term follow-up period using robust and comprehensive real-world data is necessary to provide an extensive assessment of potential health risks of OCS in COPD patients.
Prof. Gary Tse, Associate Dean and Professor in the School of Nursing and Health Studies at Hong Kong Metropolitan University, together with a team of researchers from across the globe including Dr Benjamin Emmanuel from AstraZeneca, Prof. Mona Bafadhel from King's College London, Prof. Alberto Papi from University of Ferrara, and Prof. David Price from University of Aberdeen, evaluated the associations between COPD-related OCS exposure and adverse outcomes using anonymised electronic patient medical records from primary care in England (Figure 1).
The research team studied 17 adverse outcomes, such as pneumonia, osteoporosis, cardiovascular/cerebrovascular disease, weight gain, chronic kidney disease, and death, in COPD patients who used OCS and compared them with those who were not exposed to OCS. The two groups of patients were followed for an average of 6.9 years (who used OCS) and 5.4 years (who never used OCS). The findings indicated that COPD patients who used OCS experienced a significantly higher risk of developing multiple adverse outcomes, including pneumonia, osteoporosis, cardiovascular/cerebrovascular disease, and death, in comparison with patients without any OCS exposure (Figure 2). Patients using a higher dose of OCS over time were generally more likely to experience these adverse outcomes.
These findings stress the need to increase awareness of OCS-related adverse outcomes for patients with COPD, particularly the older patients who are already at a higher risk for comorbidities associated with the adverse outcomes. They also contribute to showing that it is crucial to evaluate patients individually, identify appropriate treatments to manage and minimise the risk of COPD exacerbation, and thus reduce their exposure to OCS.
The research findings were published in the International Journal of Chronic Obstructive Pulmonary Disease with the paper title 'A long-term study of adverse outcomes associated with oral corticosteroid use in COPD'.
 Voorham J, Menzies-Gow AN, Tran TN, et al. S29 Longitudinal systemic corticosteroid utilisation for asthma and other diseases in the United Kingdom from 1990 to 2018: a population-based cohort analysis. Thorax. 2021;76(Suppl 1):A21.