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Singapore, [4 December 2023] - Results from a real-world research study have highlighted the risks associated with the long-term use of oral corticosteroids (OCS) in patients with chronic obstructive pulmonary disease (COPD). Intermittent OCS are prescribed to around one in three COPD patients in the UK as well as in most developed countries. Systemic corticosteroids are known to be related with many adverse outcomes.

The study entitled "A Long-Term Study of Adverse Outcomes Associated With Oral Corticosteroid Use in COPD," is published in this month’s issue of the International Journal of Chronic Obstructive Pulmonary Disease. The study was conducted by the Observational & Pragmatic Research Institute and sponsored by AstraZeneca.

Dr. Gary Tse, from the School of Nursing and Health Studies of the Hong Kong Metropolitan University, led the research which also involved a team of distinguished researchers from across the globe including Dr. Benjamin Emmanuel, Prof. Mona Bafadhel, Prof. Alberto Papi and Professor David Price. The study examined electronic medical records spanning 32 years (1987–2019) from the UK Clinical Practice Research Datalink, coupled with English Hospital Episode Statistics (HES). A wide range of adverse outcomes were evaluated which are known to be potentially related to treatment with corticosteroids among COPD patients compared to those not exposed to such treatments.  

Key findings which included data from 323,722 patients, revealed that 33.0% had at least one COPD-related OCS prescription. Of the eligible 58,955 patients included in the OCS cohort, the matched analysis highlighted significantly higher risks of corticosteroid related adverse outcomes compared to the non-OCS cohort. All-cause mortality was also notably elevated in the OCS cohort. These effects were worse in those with a higher dose of OCS exposure. For example, cumulative doses over 1gm of 4 lifetime courses were associated with increased risk of cardiovascular disease. 

Dr. Tse reports that, “After seven years, COPD patients that were prescribed OCS (vs. those not prescribed OCS), had significantly greater risks of osteoporosis, type-2 diabetes mellitus, or cardiovascular/cerebrovascular disease, plus a 4% greater risk of death, all with a dose-response.” 

Professor David Price, a lead researcher and corresponding author, stated, "Our study identifies a critical association between oral corticosteroid use and increased risks of adverse outcomes and mortality in COPD patients. These findings underscore the importance of careful consideration and monitoring of OCS usage, particularly concerning cumulative doses, in the management of COPD." 

This research sheds light on the implications of OCS use in COPD patients and emphasizes the need for vigilant monitoring of treatment strategies in COPD. 

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