Inhaled corticosteroid use and risk COVID-19 related death among 966,461 patients with COPD or asthma: an OpenSAFELY analysis
Inhaled corticosteroid use and risk COVID-19 related death among 966,461 patients with COPD or asthma: an OpenSAFELY analysis
Abstract BackgroundEarly descriptions of the coronavirus outbreak showed a lower prevalence of asthma and COPD than was expected for people diagnosed with COVID-19, leading to speculation that inhaled corticosteroids (ICS) may protect against infection with SARS-CoV-2, and development of serious sequelae. We evaluated the association between ICS and COVID-19 related death using linked electronic health records in the UK. MethodsWe conducted cohort studies on two groups of people (COPD and asthma) using the OpenSAFELY platform to analyse data from primary care practices linked to national death registrations. People receiving an ICS were compared to those receiving alternative respiratory medications. Our primary outcome was COVID-19 related death. FindingsWe identified 148,588 people with COPD and 817,973 people with asthma receiving relevant respiratory medications in the four months prior to 01 March 2020. People with COPD receiving ICS were at a greater risk of COVID-19 related death compared to those receiving a long-acting beta agonist (LABA) and a long-acting muscarinic antagonist (LAMA) (adjusted HR = 1.38, 95% CI = 1.08 – 1.75). People with asthma receiving high dose ICS were at an increased risk of death compared to those receiving a short-acting beta agonist (SABA) only (adjusted HR = 1.52, 95%CI = 1.08 – 2.14); the adjusted HR for those receiving low-medium dose ICS was 1.10 (95% CI = 0.82 – 1.49). Quantitative bias analyses indicated that an unmeasured confounder of only moderate strength of association with exposure and outcome could explain the observed associations in both populations. InterpretationThese results do not support a major role of ICS in protecting against COVID-19 related deaths. Observed increased risks of COVID-19 related death among people with COPD and asthma receiving ICS can be plausibly explained by unmeasured confounding due to disease severity. FundingThis work was supported by the Medical Research Council MR/V015737/1.
Evans Stephen JW、Wing Kevin、The OpenSAFELY Collaborative、Schultze Anna、Walker Alex J、MacKenna Brian、Rentsch Christopher T、Croker Richard、Bacon Seb、Cockburn Jonathan、McDonald Helen I、Quint Jennifer、Smeeth Liam、Evans David、Hester Frank、Mathur Rohini、Mehrkar Amir、Hulme William、Forbes Harriet、Williamson Elizabeth、Tomlinson Laurie、Curtis Helen J、Bates Chris、Bhaskaran Krishnan、Goldacre Ben、Morton Caroline E、Inglesby Peter、Harper Sam、Wong Angel YS、Parry John、Brown Jeremy P、Douglas Ian J、Drysdale Henry
London School of Hygiene and Tropical MedicineLondon School of Hygiene and Tropical MedicineLondon School of Hygiene and Tropical MedicineThe DataLab, Nuffield Department of Primary Care Health Sciences, University of OxfordThe DataLab, Nuffield Department of Primary Care Health Sciences, University of OxfordLondon School of Hygiene and Tropical MedicineThe DataLab, Nuffield Department of Primary Care Health Sciences, University of OxfordThe DataLab, Nuffield Department of Primary Care Health Sciences, University of OxfordTPP, TPP House, 129 Low Lane, HorsforthLondon School of Hygiene and Tropical Medicine||NIHR Health Protection Research Unit (HPRU) in ImmunisationNational Heart and Lung Institute, Imperial CollegeLondon School of Hygiene and Tropical Medicine||NIHR Health Protection Research Unit (HPRU) in ImmunisationThe DataLab, Nuffield Department of Primary Care Health Sciences, University of OxfordTPP, TPP House, 129 Low Lane, HorsforthLondon School of Hygiene and Tropical MedicineThe DataLab, Nuffield Department of Primary Care Health Sciences, University of OxfordThe DataLab, Nuffield Department of Primary Care Health Sciences, University of OxfordLondon School of Hygiene and Tropical MedicineLondon School of Hygiene and Tropical MedicineLondon School of Hygiene and Tropical MedicineThe DataLab, Nuffield Department of Primary Care Health Sciences, University of OxfordTPP, TPP House, 129 Low Lane, HorsforthLondon School of Hygiene and Tropical MedicineThe DataLab, Nuffield Department of Primary Care Health Sciences, University of OxfordThe DataLab, Nuffield Department of Primary Care Health Sciences, University of OxfordThe DataLab, Nuffield Department of Primary Care Health Sciences, University of OxfordTPP, TPP House, 129 Low Lane, HorsforthLondon School of Hygiene and Tropical MedicineTPP, TPP House, 129 Low Lane, HorsforthLondon School of Hygiene and Tropical MedicineLondon School of Hygiene and Tropical MedicineThe DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford
医药卫生理论医学研究方法内科学
COVID-19Pulmonary DiseaseChronic ObstructiveAsthmaSteroidsPharmacoepidemiology
Evans Stephen JW,Wing Kevin,The OpenSAFELY Collaborative,Schultze Anna,Walker Alex J,MacKenna Brian,Rentsch Christopher T,Croker Richard,Bacon Seb,Cockburn Jonathan,McDonald Helen I,Quint Jennifer,Smeeth Liam,Evans David,Hester Frank,Mathur Rohini,Mehrkar Amir,Hulme William,Forbes Harriet,Williamson Elizabeth,Tomlinson Laurie,Curtis Helen J,Bates Chris,Bhaskaran Krishnan,Goldacre Ben,Morton Caroline E,Inglesby Peter,Harper Sam,Wong Angel YS,Parry John,Brown Jeremy P,Douglas Ian J,Drysdale Henry.Inhaled corticosteroid use and risk COVID-19 related death among 966,461 patients with COPD or asthma: an OpenSAFELY analysis[EB/OL].(2025-03-28)[2025-07-16].https://www.medrxiv.org/content/10.1101/2020.06.19.20135491.点此复制
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