Inhaled corticosteroids and adverse outcomes among chronic obstructive pulmonary disease patients with community-acquired pneumonia: a population-based cohort study.
cohort study
community-acquired pneumonia
inhaled corticosteroids
mortality
pleural empyema
Journal
Frontiers in medicine
ISSN: 2296-858X
Titre abrégé: Front Med (Lausanne)
Pays: Switzerland
ID NLM: 101648047
Informations de publication
Date de publication:
2023
2023
Historique:
received:
12
03
2023
accepted:
10
07
2023
medline:
9
8
2023
pubmed:
9
8
2023
entrez:
9
8
2023
Statut:
epublish
Résumé
While inhaled corticosteroids (ICS) may increase pneumonia risk in patients with chronic obstructive pulmonary disease (COPD), the impact of ICS on pneumonia outcomes is debated. We examined whether ICS use is associated with adverse outcomes among COPD patients with community-acquired pneumonia (CAP). Population-based cohort study of all COPD patients with an incident hospitalization for CAP between 1997 and 2013 in Northern Denmark. Information on medications, COPD severity, comorbidities, complications, and death was obtained from medical databases. Adjusted risk ratios (aRRs) for pleuropulmonary complications, intensive care unit (ICU) admissions, and 30-day mortality in current and former ICS users were compared with those in non-users, using regression analyzes to handle confounding. Of 11,368 COPD patients with CAP, 6,073 (53.4%) were current ICS users and 1,733 (15.2%) were former users. Current users had a non-significantly decreased risk of pleuropulmonary complications [2.6%; aRR = 0.82 (0.59-1.12)] compared to non-users (3.2%). This was also observed among former users [2.5%; aRR = 0.77 (0.53-1.12)]. Similarly, decreased risks of ICU admission were observed among current users [aRR = 0.77 (0.57-1.04)] and among former users [aRR = 0.81 (0.58-1.13)]. Current ICS users had significantly decreased 30-day mortality [9.1%; aRR = 0.72 (0.62-0.85)] compared to non-users (12.6%), with a stronger association observed among patients with frequent exacerbations [0.58 (0.39-0.86)]. No significant association was observed among former ICS users [0.89 (0.75-1.05)]. Our results suggest a decreased risk of death with ICS use among COPD patients admitted for CAP.
Identifiants
pubmed: 37554496
doi: 10.3389/fmed.2023.1184888
pmc: PMC10405521
doi:
Types de publication
Journal Article
Langues
eng
Pagination
1184888Informations de copyright
Copyright © 2023 Basille, Wang, Thomsen, Menon, Shetty, Duhaut, Andrejak, Jounieaux and Sørensen.
Déclaration de conflit d'intérêts
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Références
Am J Respir Crit Care Med. 2006 Apr 1;173(7):736-43
pubmed: 16424444
Eur Respir J. 2011 Feb;37(2):393-9
pubmed: 20595152
Eur Respir J. 2017 Mar 6;49(3):
pubmed: 28182564
Eur Respir J. 2017 Nov 22;50(5):
pubmed: 29167301
Chest. 2013 Apr;143(4):1009-1017
pubmed: 23187314
BMC Pulm Med. 2017 Apr 20;17(1):66
pubmed: 28427381
Respir Med. 2011 Jul;105(7):1063-8
pubmed: 21320769
Cochrane Database Syst Rev. 2017 Feb 10;2:CD012066
pubmed: 28185242
Eur Respir J. 2010 Oct;36(4):751-7
pubmed: 20413535
Clin Microbiol Infect. 2020 Feb;26(2):220-226
pubmed: 31254714
Eur Respir J. 2019 Feb 14;53(2):
pubmed: 30765484
Am J Epidemiol. 2004 Apr 1;159(7):702-6
pubmed: 15033648
Am J Respir Crit Care Med. 2017 May 15;195(10):1402-1404
pubmed: 28165763
Eur Respir J. 2018 Feb 21;51(2):
pubmed: 29467200
Clin Epidemiol. 2016 Oct 25;8:525-530
pubmed: 27822095
Clin Epidemiol. 2016 Oct 25;8:673-678
pubmed: 27822114
Respir Med. 2010 Feb;104(2):246-52
pubmed: 19879745
Lancet Respir Med. 2014 Nov;2(11):919-932
pubmed: 25240963
Pulm Pharmacol Ther. 2017 Feb;42:1-6
pubmed: 27864038
Int J Chron Obstruct Pulmon Dis. 2018 Jul 05;13:2089-2099
pubmed: 30013336
COPD. 2016 Jun;13(3):312-26
pubmed: 26645797
Lung. 2017 Jun;195(3):281-288
pubmed: 28255905
BMJ. 2013 May 29;346:f3306
pubmed: 23719639
N Engl J Med. 2023 May 25;388(21):1931-1941
pubmed: 36942789
Am J Respir Crit Care Med. 2018 Jul 1;198(1):128-131
pubmed: 29461860
Am J Respir Crit Care Med. 2013 Jun 1;187(11):1241-8
pubmed: 23590264
Ther Adv Respir Dis. 2016 Jun;10(3):235-55
pubmed: 26893311
Thorax. 2013 Nov;68(11):1029-36
pubmed: 24130228
Eur Respir J. 2019 Sep 5;54(3):
pubmed: 31488585
N Engl J Med. 2007 Feb 22;356(8):775-89
pubmed: 17314337
Respirology. 2014 Aug;19(6):929-35
pubmed: 24909304
Epidemiology. 2016 Jul;27(4):525-30
pubmed: 27075676
Eur Respir J. 2019 May 18;53(5):
pubmed: 30846476
Clin Epidemiol. 2019 Jul 12;11:563-591
pubmed: 31372058
Clin Epidemiol. 2013;5:9-12
pubmed: 23359787
Am J Respir Crit Care Med. 2011 Aug 1;184(3):312-6
pubmed: 21512168
Am J Respir Crit Care Med. 2004 Oct 1;170(7):760-5
pubmed: 15229100
J Intern Med. 2006 Apr;259(4):410-7
pubmed: 16594909
Pulm Pharmacol Ther. 2015 Feb;30:44-50
pubmed: 25445928
Diabetes Obes Metab. 2020 Aug;22(8):1348-1356
pubmed: 32239604
Int J Chron Obstruct Pulmon Dis. 2021 Mar 10;16:603-613
pubmed: 33731990