Effects of glucocorticoid administration routes on patients with acute exacerbations of chronic obstructive pulmonary disease in China: A propensity score-matched longitudinal analysis

Abstract Background: Glucocorticoids are widely used for managing acute exacerbations of chronic obstructive pulmonary disease (AECOPD); however, limited studies have described the comparative effectiveness of inhaled corticosteroids (ICS), systemic corticosteroids administered orally or intravenously (oral/intra), and a combination of ICS and oral/intra for AECOPD treatment in China. Thus, we aimed to explore the effects of different glucocorticoid administration routes during hospitalization on both short- and long-term patient prognosis in AECOPD. Methods: Data were collected from the Acute Exacerbations of Chronic Obstructive Pulmonary Disease Inpatient Registry study, a nationwide multicenter, prospective, observational study conducted in China from September 2017 to November 2021. The study involved 179 hospitals. The patients were categorized into three groups according to their treatment profiles as follows: (1) ICS alone, (2) ICS combined with oral/intra, and (3) oral/intra. Propensity score-matching was utilized to minimize potential bias, using a caliper value <0.1. Competing risk models were used to calculate the relative risks for short-(30 days) and long-term (12 months) severe exacerbations, COPD-specific readmission, and all-cause readmission. Results: After propensity score matching, each group included 572 patients. In the ICS group, the cumulative incidence of short-term severe exacerbations, COPD-specific readmission, and all-cause readmission was 2.4%, 2.2%, and 2.7%, respectively, which was comparable to that in the ICS + oral/intra group (3.7%, 3.4%, and 4.2%, respectively). However, the incidence in the ICS + oral/intra group was significantly lower than that in the oral/intra group (5.4% for short-term severe exacerbations, 5.2% for COPD-specific readmission, and 5.7% for all-cause readmission). The 12-month incidence did not significantly differ among the groups. Compared with the ICS group, the short- or long-term risks did not differ in the ICS + oral/intra group, whereas the short-term risk was higher in the oral/intra group (severe exacerbations: hazards ratio [HR] = 2.29, 95% confidence interval [CI]: 1.09–4.82; COPD-specific readmission: HR = 2.44, 95% CI: 1.12–5.30; and all-cause readmission: HR = 2.18, 95% CI: 1.07–4.45). Conclusion: The use of systemic corticosteroids alone during hospitalization for AECOPD increases the short-term risk of outcomes but does not affect the long-term prognosis.