Oral corticosteroid use and sarcopenia-related traits in older people with chronic airway disease: a population-based study

Elizabeth Benz; Lies Lahousse; Johnmary T Arinze; Sara Wijnant; Maria de Ridder; Fernando Rivadeneira; Guy Brusselle; Bruno H Stricker

doi:10.1183/23120541.00492-2023

Oral corticosteroid use and sarcopenia-related traits in older people with chronic airway disease: a population-based study

ERJ Open Res. 2023 Sep 25;9(5):00492-2023. doi: 10.1183/23120541.00492-2023. eCollection 2023 Sep.

Authors

Elizabeth Benz^{1

2}, Lies Lahousse^{1

3}, Johnmary T Arinze^{4

5}, Sara Wijnant^{1

4}, Maria de Ridder⁵, Fernando Rivadeneira², Guy Brusselle^{1

4}, Bruno H Stricker¹

Affiliations

¹ Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
² Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
³ Department of Bioanalysis, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium.
⁴ Department of Respiratory Medicine, Ghent University Hospital, Ghent University, Ghent, Belgium.
⁵ Department of Medical Informatics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.

Abstract

Background: Sarcopenia is characterised by two major phenotypic components: low handgrip strength (HGS) and appendicular skeletal muscle index (ASMI). Oral corticosteroid (OCS) use is an important medication for acute respiratory exacerbations in patients with COPD and asthma. However, the association of OCS and sarcopenia components in older people is largely unexplored. The aim of this study was to examine the association between OCS use and HGS or ASMI in the general population and explore interactions with chronic airway diseases.

Methods: From the population-based Rotterdam Study, 5054 participants (age 69.0±8.8 years; 56% females) were included in the cross-sectional analysis and 1324 in the longitudinal analysis. Associations between OCS and muscle strength and mass were analysed using linear regression models adjusted for age, sex, fat %, height, kidney function, smoking and comorbidities.

Results: At baseline, ever-OCS users had lower handgrip strength (β= -0.48, 95% CI -0.84- -0.12) than never-OCS users, with cumulative frequency (≥10 OCS prescriptions)-dependent effects (β= -1.25, 95% CI -2.16- -0.33). COPD ever-OCS users, but not asthma, had lower handgrip strength (β= -0.98, 95% CI -1.91- -0.06) and lower lean mass (β= -0.14, 95% CI -0.27- -0.01) than never-OCS users. After 5.6 years of follow-up in those free of sarcopenia traits at baseline, COPD ever-OCS users developed lower handgrip strength (β= -1.64, 95% CI -2.87- -0.40) with frequency (β= -3.64, 95% CI -6.57- -0.72) and duration (β= -1.51, 95% CI -2.87- -0.15) association compared to never-OCS users.

Conclusions: OCS use is associated with a decline in handgrip strength in people with COPD in a cumulative frequency and duration-dependent manner. Routine muscle examination may be necessary for patients with COPD.