Persistent Steroid Exposure Before Coronavirus Disease 2019 Diagnosis and Risk of Hospitalization in Patients With Chronic Obstructive Pulmonary Disease

It is unclear whether persistent inhaled steroid exposure in chronic obstructive pulmonary disease (COPD) patients before coronavirus disease 2019 (COVID-19) is associated with hospitalization risk. To examine the association between persistent steroid exposure and COVID-19-related hospitalization risk in COPD. This retrospective cohort study used electronic health records from the Kaiser Permanente Northern California healthcare system (February 2, 2020, to September 30, 2020) for patients aged ≥40 years with COPD and a positive polymerase chain reaction test result for COVID-19. Primary exposure was persistent oral and/or inhaled steroid exposure defined as ≥6 months of prescriptions filled in the year before COVID-19 diagnosis. Multivariable logistic regression was performed for the primary outcome of COVID-19-related hospitalization or death/hospice referral. Steroid exposure in the month before COVID-19 diagnosis was a covariate. Of >4.3 million adults, 697 had COVID-19 and COPD, of whom 270 (38.7%) had COVID-19-related hospitalizations. Overall, 538 (77.2%) were neither exposed to steroids in the month before COVID-19 diagnosis nor persistently exposed; 53 (7.6%) exposed in the month before but not persistently; 23 (3.3%) exposed persistently but not in the month before; and 83 (11.9%) exposed both persistently and in the month before. Adjusting for all confounders including steroid use in the month before, the odds ratio for hospitalization was 0.77 (95% CI 0.41-1.46) for patients persistently exposed to steroids before COVID-19 diagnosis. No association was observed between persistent steroid exposure and the risk of COVID-19-related hospitalization in COPD patients.

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