Regular Inhaled Corticosteroids Use May Protect Against Severe COVID-19 Outcome in COPD
2023 (English)In: The International Journal of Chronic Obstructive Pulmonary Disease, ISSN 1176-9106, E-ISSN 1178-2005, Vol. 18, p. 1701-1712Article in journal (Refereed) Published
Abstract [en]
Purpose: Population-based studies provide conflicting evidence about how inhaled corticosteroids (ICS) impact COVID-19 outcomes among COPD patients. We investigated whether regular ICS exposure affects risk, severity, or survival in SARS-CoV-2 infection, using a nationwide linked Swedish population register database.Patients and Methods: During January-December 2020, we studied two defined Swedish adult populations - Whole population [?40 years] (N = 5243479), and COPD subpopulation [?40 years] (N = 133372), in three study cohorts, respectively: 1. Overall cohort (index date 1 Jan 2020), 2. COVID-19 diagnosed sub-cohort (index date = diagnosis date), and 3. COVID-19 hospitalized sub-cohort (index date = admission date). Regular exposure was defined as ?3 ICS prescriptions in the year before index. Hazard ratios (HRs) for outcomes (COVID-19 onset, hospitalization, ICU admission, or death) related to ICS exposure were estimated using Cox regression. Confounding was controlled by propensity score methods applying Average Treatment effect in the Treated (ATT) weighting.Results: Regular ICS use was associated with only very slightly increased onset of COVID-19, hospitalization, ICU admission, and death in the overall whole population cohort and in the overall COPD subpopulation cohort, except for ICU admission (marginally non-significant HRs, up to 1.13); and no clear increase in the diagnosed sub-cohorts. However, in the COVID-19 hospitalized COPD sub-cohort, ICS therapy showed reduced risks against progression to ICU admission and death, significant for death (HR 0.82 95% CI [0.67-0.99]).Conclusion: For COPD patients, ICS therapy offers some protection against progression to ICU admission and death among COVID-19 hospitalized patients. Our findings alleviate concerns about increased risks of COVID-19 by ICS treatment and provide evidence supporting the continuation of ICS therapy for COPD patients.
Place, publisher, year, edition, pages
DOVE MEDICAL PRESS LTD , 2023. Vol. 18, p. 1701-1712
Keywords [en]
COVID-19; COPD; mortality
National Category
Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:liu:diva-197921DOI: 10.2147/COPD.S404913ISI: 001047776200001PubMedID: 37576828OAI: oai:DiVA.org:liu-197921DiVA, id: diva2:1798944
Note
Funding Agencies|Swedish government [ALFGBG-938453, ALFGBG-978954, ALFGBG-971130]; Swedish county councils, the ALF agreement [ALFGBG-938453, ALFGBG-978954, ALFGBG-971130]; Swedish Research Council for Sustainable Development [2020-02828]; Swedish Heart-Lung Foundation [20210030, 20210581]
2023-09-202023-09-202024-05-03