Inhaled corticosteroids (including when combined with LABA) reduce the rate of exacerbations however they do not improve mortality and their effect on the decline in lung function remains unclear. They should be considered for patients with severe COPD and frequent exacerbations (. two or more exacerbations in a year requiring treatment with an antibiotic or oral corticosteroid). Systemic absorption may occur, especially when high doses are used, therefore the benefit of ICS must be weighed against the risk of adverse effects, such as bruising, cataracts and osteoporosis.
Oxygen therapy is frequently provided along with pharmacological interventions to treat underlying hypoxemia in COPD patients. By reducing hypoxia in the alveoli, pulmonary vasoconstriction is reduced. Reducing pulmonary hypertension lowers right heart afterload, and improves right heart systolic function. Oxygen also reduces hypoxemia in the blood, which reduces the risk of developing polycythemia. However, oxygen therapy has only been shown to reduce mortality in those with severe hypoxemia (PaO2 < 55mmHg); otherwise there is no mortality benefit.
Of 79,985 patients, 73,765 (92%) were initially treated with intravenous steroids, whereas 6220 (8%) received oral treatment. We found that % (95% confidence interval [CI], %-%) of the intravenously and % (95% CI, %-%) of the orally treated patients died during hospitalization, whereas % (95% CI, %-%) of the intravenously and % (95% CI, %-%) of the orally treated patients experienced the composite outcome. After multivariable adjustment, including the propensity for oral treatment, the risk of treatment failure among patients treated orally was not worse than for those treated intravenously (odds ratio [OR], ; 95% CI, -). In a propensity-matched analysis, the risk of treatment failure was significantly lower among orally treated patients (OR, ; 95% CI, -), as was length of stay and cost. Using an adaptation of the instrumental variable approach, increased rate of treatment with oral steroids was not associated with a change in the risk of treatment failure (OR for each 10% increase in hospital use of oral steroids, ; 95% CI, -). A total of 1356 (22%) patients initially treated with oral steroids were switched to intravenous therapy later in the hospitalization.