• Eyal Kleinhendler, Noa Shopen, Neta Cohen, Ophir Freund, Tal Perluk, Evgeni Gershman, Avraham Unterman, and Amir Bar-Shai.
• Division of Pulmonary Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; and Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. eyalkl@tlvmc.gov.il.
• Respir Care. 2024 Jul 30.

BackgroundCOPD exacerbations are a major cause of morbidity and mortality. Although inhaled corticosteroids (ICS) have a role as long-term treatment, their efficacy in exacerbations, particularly as an adjunct to systemic steroids, remains unclear.MethodsIn this retrospective observational study, we analyzed data from 870 subjects admitted with COPD exacerbations to a tertiary medical center in Israel from January 2018-January 2023. We investigated the impact of adding ICS to standard systemic steroid treatment on hospital length of stay, intubation rates, and 30-d mortality using propensity score matching to account for confounders.ResultsThe cohort, after matching, included 354 subjects treated with systemic steroids and ICS and 121 treated with systemic steroids alone. All characteristics were similar between the groups. Our analysis showed no differences in 30-d mortality (7.1% vs 5.8%, P = .63) or secondary outcomes (intubation, hospital length of stay, and readmission rates) between the groups. Subgroup analyses based on different eosinophil levels did not alter these findings. In multivariate analysis among the general cohort, eosinophil count < 150 cells/μL (adjusted odds ratio 0.45 [95% CI 0.21-0.87], P = .02) and high Charlson score (adjusted odds ratio 1.19 [95% CI 1.02-1.37], P = .02) were independent predictors for 30-d mortality.ConclusionsDespite the known benefits of ICS in managing chronic COPD, we did not find an added value of ICS to systemic steroids in exacerbations. These results underscore the necessity for individualized treatment strategies and further research into the role of ICS in COPD exacerbations.Copyright © 2024 by Daedalus Enterprises.

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