Inhaled Corticosteroids and All-Cause Mortality Risk in Patients With COPD

Benefit of inhaled corticosteroids for sinusitis small
Benefit of inhaled corticosteroids for sinusitis small
How does treatment with inhaled corticosteroids affect all-cause mortality risk among patients with COPD, and what factors influence the effect of ICS treatment on mortality?

Use of inhaled corticosteroids (ICS) in patients with chronic obstructive pulmonary disease (COPD) was associated with a reduction in all-cause mortality risk, particularly among patients using triple therapy lasting longer than 6 months and in patients with an eosinophil count of 200/μL or higher. These are among meta-analysis findings published in Chest.

It is not known whether ICS treatment reduces all-cause mortality risk in patients with COPD. Researchers in China therefore conducted a meta-analysis of 60 randomized controlled trials pooled from the PubMed, Cochrane Library, Embase, and Clinical databases. The meta-analysis included 103,034 patients.

Compared with patients on inhaled therapy alone, a reduction in all-cause mortality was found among patients with COPD treated with ICS therapy (Peto OR 0.90; 95% CI, 0.84-0.97), and an even greater reduction with triple therapy (Peto OR 0.73; 95% CI, 0.59-0.91). This reduction was also strongly associated with several treatment-related factors, including: treatment duration extending beyond 6 months (Peto OR 0.90; 95% CI, 0.83-0.97), use of budesonide (Peto OR, 0.75; 95% CI, 0.59-0.94), use of medium-dose ICS (Peto OR 0.71; 95% CI, 0.56-0.91), and use of low-dose ICS (Peto OR 0.88; 95% CI, 0.79-0.97).

Several patient-related factors were also important. A patient eosinophil count of at least 200/μL was the best predictor (Peto OR 0.58; 95% CI, 0.36-0.95) of reduced all-cause mortality with ICS use. Additional predictors included patient age of less than 65 years, body-mass index of 25 or more, occurrence of 2 or more moderate or severe exacerbations in the previous year, and patient classification as Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage III or IV.

Meta-analysis limitations include publication bias, selection bias, heterogeneity in the included RCTs, and lack of subgroup analysis for some important patient characteristics.

“Inhaled therapy containing ICSs, especially triple therapy, longer than 6 months, was associated with a reduction in the cause-death risk in COPD patients,” the researchers concluded. “The predictors of this association included medication factors and patient characteristics, among which eosinophil counts equal to or greater than 200/μL was the strongest predictor.”


Chen H, Deng ZX, Sun J, et al. Association of inhaled corticosteroids with all-cause death risk in COPD patients: a meta-analysis of 60 randomized controlled trials. Chest. Published online July 31, 2022. doi:10.1016/j.chest.2022.07.015