The use of oral corticosteroids and the risk of death from Chronic Obstructive Pulmonary Disease (COPD) /

We investigated the use of oral corticosteroids (OCS) among patients with chronic obstructive pulmonary disease (COPD) and the subsequent risk of death from all causes, COPD, cardiac problems, and pneumonia. We identified an incident cohort of 2050 patients with COPD using the Saskatchewan Health databases. We matched 668 case patients who died with 6742 controls with respect to date of entry into the cohort. A nested case-control analysis was then conducted using conditional multivariate regression. The matched adjusted rate ratio (RR) of all cause mortality for any use of OCS was 1.48 (95% CI 1.18--1.84). An increased risk of death was also shown with cumulative dose (RR 1.17; 95% CI 1.08--1.25) and average yearly dose (RR 1.31; 95% CI 1.19--1.43). A dose-related increase in the adjusted rate ratios for cumulative OCS doses above 250 mg was observed. The risk is particularly evident among patients filling prescriptions for OCS in the 12 months before death. An increased risk of death from COPD was found, but no significant association was found for cardiac and pneumonia mortality. Although the results suggest the use of OCS increases the risk death among COPD patients, the possibility of confounding by indication and channelling may have influenced the results