OP2 ASSOCIATION BETWEEN ICS EXPOSURE AND MORTALITY AMONG COPD PATIENTS IN MALAYSIA: EXACOS-MY STUDY

Aisya Natasya Musa1,2, Ahmad Izuanuddin Ismail1,2, Syazatul Syakirin Sirol Aflah3, Chee Kuan Wong4
1 Faculty of Medicine, Universiti Teknologi MARA (UiTM), Sungai Buloh, Selangor, Malaysia
2 Hospital Al-Sultan Abdullah Universiti Teknologi MARA (UiTM), Kampus Puncak Alam, Puncak Alam, Malaysia
3 Institut Perubatan Respiratori, Hospital Kuala Lumpur, Jalan Pahang, Kuala Lumpur, Malaysia
4 Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia

Introduction:

The role of inhaled corticosteroids (ICS) in COPD treatment remains debatable due to concerns of side effects, despite IMPACT and ETHOS study showed reduced mortality in patients treated with triple therapy. The impact of ICS use on mortality rate in COPD patients with history of severe exacerbation has not been reported in Malaysia.

Objective:

To analyse the association between ICS exposure and mortality among COPD patients in Malaysia.

Methods:

The EXACerbations and their OutcomeS among COPD patients in MalaYsia (EXACOS-MY) study was an observational multicentre (3 tertiary hospitals) cross-sectional study in Malaysia. Inclusion criteria were: confirmed diagnosis of COPD, availability of COPD-related medical records for at least three years, and history of at least one severe exacerbation. Collected data were analysed to study the association between ICS use and mortality.

Results:

A total of 471 patients were included in the study. Majority (94.3%) were male, Malay (57.1%), GOLD D (69.6%) and had a mean age of 72.38 ± 9.11 years old. 81.1% were ex-smokers while 16.3% were current smokers. At baseline, 8% were on ICS alone, 20% were on ICS/LABA and 18% were on triple therapy combination. 24.8% had high blood eosinophils (≥300 cells/μL). There were 85 deaths (18.1%) recorded with 31 deaths being respiratory related. Following a severe exacerbation event, mortality rate was significantly reduced among patients initiated on ICS (38/265 patients; 14.3%), compared with patients who did not receive any ICS (47/206 patients; 22.8%) (p = 0.018). A similar trend was also observed among patients who received any ICS within the 3 years, regardless of exacerbation event (46/298 patients; 15.4%), compared with patients without any ICS use (39/173 patients; 22.5%) (p = 0.053).

Conclusions:

Use of ICS in COPD patients with a history of severe exacerbation is associated with a significant reduction in mortality rate.