BMI and oral glucocorticoids as predictors of prognosis in COPD patients on long-term oxygen therapy

Abstract

Aims: The objectives of the study were to determine whether body mass index (BMI), and oral corticosteroid use predict survival and hospitalization in hypoxaemic chronic obstructive pulmonary disease (COPD) patients. Methods: The study was a prospective cohort study with analysis of a nationwide database (Danish Oxygen Register). We studied survival and hospitalization in 221 hypoxaemic COPD patients who were on long-term oxygen therapy (LTOT). Results: Low BMI was strongly associated with high mortality (P < 0.001). Maintenance treatment with steroids was only associated with higher mortality in overweight patients (BMI > 25 kg/mi²), RR = 3.8 (1.4-10.5), P = 0.011. Whereas BMI had no influence on risk of any hospitalization in patients using oral steroids, high BMI was independently associated with reduced risk of any hospitalization in patients without oral steroids [the RR of any hospitalization for each 1 kg/M² increase in BMI was 0.94 (CI: 0.90-0.99), P = 0.009]. Overall, the use of oral steroids was associated with increased risk of any hospitalization, RR = 1.7 (1.2-2.4), P = 0.002. This increase was especially pronounced in the group with BMI above 25 kg/M², where steroid treatment increased the risk of any hospitalization with RR = 3.6 (1.5-8.7), P = 0.005. Conclusions: In hypoxaemic patients on LTOT, low BMI is an independent risk factor of death and any hospitalization. Maintenance treatment with oral corticosteroids is associated with increased mortality and hospitalization in COPD patients with high BMI. Our findings suggest that loss of body weight should be avoided, and that oral corticosteroids should be used cautiously in patients on LTOT-especially those with high BMI. Further research on the role of changes in body composition as a prognostic factor is needed.

Keywords

corticosteroid home care hospitalization nutrition oxygen inhalation therapy survival

References

1. Wilson DO , Rogers RM , Wright EC et al. Body weight in chronic obstructive pulmonary disease: The National Institute of Health intermittent Positive-Pressure Breathing Trial . Am Rev Respir Dis 1989; 139: 1435-1438 .

2. Górecka D , Gorzelak K , Sliwinski P et al. Effect of long term oxygen therapy on survival in patients with chronic obstructive pulmonary disease with moderate hypoxaemia . Thorax 1997; 52: 674-679 .

3. Landbo C , Prescott E , Lange P et al. Prognostic value of nutritional status in chronic obstructive pulmonary disease . Am J Respir Crit Care Med 1999; 160: 1856-1861 .

4. Schols AMWJ , Slangen J , Volovics L et al. Weight loss is a reversible factor in the prognosis of chronic obstructive pulmonary disease . Am J Respir Crit Care Med 1998; 157: 1791-1797 .

5. Gray-Donald K , Gibbons L , Shapiro SH et al. Nutritional status and mortality in chronic obstructive pulmonary disease . Am J Respir Crit Care Med 1996; 153: 961-966 .

6. Chailleux E , Laaban J-P , Veale D . Prognostic value of nutritional depletion in patients with COPD treated by long-term oxygen therapy. Data from the ANTADIR observatory . Chest 2003; 123: 1460-1466 .

7. Strom K . Oral corticosteroid treatment during long-term oxygen therapy in chronic obstructive pulmonary disease: a risk factor for hospitalisation and mortality in woman . Respir Med 1998; 92: 50-56 .

8. Medical Research Council . Long term domiciliary oxygen therapy in chronic hypoxic cor pulmonale complicating chronic bronchitis and emphysema. Report of a working party . Lancet 1981; i: 681-686 .

9. Pauwels RA , Buist AS , Calverley PMA et al., on behalf of the GOLD Scientific Committee. Global strategy for diagnosis, management, and prevention of chronic obstructive pulmonary disease. NHLBI/WHO Global initiatives for chronic obstructive lung disease (GOLD). Am J Respir Crit Care Med 2001; 163: 1256-1276 .

10.

10. Nocturnal Oxygen Therapy Trial Group . Continuous or noctumal oxygen therapy in hypoxaemic chronic obstructive lung disease: A clinical trial . Ann Intern Med 1980; 93: 391-398 .

11.

11. Zielinski J , Sliwinsky , Tobiasz M et al. Long-term oxygen therapy in Poland . Monaldi Arch Chest Dis 1993; 48: 479-480 .

12.

12. Schols AMWJ , Soeters PB , Dingemans AMC et al. Prevalence and characteristics of nutritional depletion in patients with stable COPD eligible for pulmonary rehabilitation . Am Rev Respir Dis 1993; 147 1151-1156 .

13.

13. Schols AMW , Mostert R , Soeters PB et al. Body composition and exercise performance in patients with chronic obstructive pulmonary disease . Thorax 1991; 46: 695-699 .

14.

14. Donahoe M , Rogers RM , Wilson DO et al. Oxygen consumption of the respiratory muscles in normal and malnourished patients with chronic obstructive pulmonary disease . Am Rev Respir Dis 1989; 140: 385-391 .

15.

15. Gray-Donald K , Gibbons L , Shapiro SH et al. Effect of nutritional status on exercise performance in patients with chronic obstructive pulmonary disease . Am Rev Respir Dis 1989; 140: 1544-1548 .

16.

16. Efthimiou J , Flemming J , Gomes C et al. The effect of supplementary oral nutrition in poorly nourished patients with chronic obstructive pulmonary disease . Am Rev Respir Dis 1988; 137: 1075-1082 .

17.

17. Braun SR , Keim NL , Dixon RM et al. The prevalence and determinants of nutritional changes in chronic obstructive pulmonary disease . Chest 1984; 86: 558-563 .

18.

18. Fiaccadori E , Del Canale S , Coffrini E et al. Hypercapnic-hypoxemic chronic obstructive pulmonary disease (COPD): influence of severity of COPD on nutritional status . Am J Clin Nutr 1988; 48 680-685 .

19.

19. Soriano JB , Vestbo J , Pride NB et al. Survival in COPD patients after regular use of fluticasone propionate and salmeterol in general practice . Eur Respir J 2002; 20: 819-825 .

20.

20. Sin DD , Tu JV Inhaled corticosteroids and the risk of mortality and readmission in elderly patients with chronic obstructive pulmonary disease . Am J Respir Crit Care Med 2001; 164: 580-584 .

21.

21. Groenewegen KH , Schols AMWJ , Wouter EFM . Mortality and mortality-related factors after hospitalisation for acute exacerbation of COPD . Chest 2003; 124: 459-467 .

22.

22. Schols AMWJ , Wesseling G , Kester ADM et al. Dose dependent increased mortality risk in COPD patients treated with oral glucocorticoids . Eur Respir J 2001; 17: 337-342 .

23.

23. McEvoy CE , Niewoehner DE . Adverse effects of corticosteroids therapy for COPD: a critical review . Chest 1997; 111: 732-743 .

24.

24. Decramer M , Brock V , Dom R . Functional and histologic picture of steroid-induced myopathy in chronic obstructive pulmonary disease . Am J Respir Crit Care Med 1996; 153: 1958-1964 .

25.

25. Decramer M , Gosselink R , Troosters T et al. Muscle weakness is related to utilization of health care resources in COPD patients . Eur Respir J 1997; 10: 417-423 .

26.

26. Marquis K , Debigare R , Lacasse Y et al. Midthigh muscle cross-sectional area is a better predictor of mortality than body mass index in patients with chronic obstructive pulmonary disease . Am J Respir Crit Care Med 2002; 166: 787-789 .

27.

27. Braun SR , Dixon RM , Keim NL et al. Predictive clinical value of nutritional assessment factors in COPD . Chest 1984; 85: 353-357 .

28.

28. Pouw EM , Ten Velde GPM , Croonen BHPM et al. Early non-elective readmission for chronic obstructive pulmonary disease is associated with weight loss . Clin Nutr 2000; 19: 95-99 .

29.

29. Burge PS , Calverley PM , Jones PW et al. Randomised, double blind, placebo controlled study of fluticasone propionate in patients with moderate to severe chronic obstructive pulmonary . Br Med J 2000; 320: 1297-1303 .