Inhaled Corticosteroids in Patients with Chronic Obstructive Pulmonary Disease and Risk of Acquiring Streptococcus pneumoniae Infection. A Multiregional Epidemiological Study

Christian Kjer Heerfordt*, Josefin Eklöf, Pradeesh Sivapalan, Truls Sylvan Ingebrigtsen, Tor Biering-Sørensen, Zitta Barrella Harboe, Jesper Koefod Petersen, Christian Østergaard Andersen, Jonas Bredtoft Boel, Anne Kathrine Bock, Alexander G Mathioudakis, John R Hurst, Shailesh Kolekar, Sofie Lock Johansson, Jette Marie Bangsborg, Jens Otto Jarløv, Ram Benny Dessau, Christian Borbjerg Laursen, Michael Perch, Jens-Ulrik Stæhr Jensen

*Corresponding author af dette arbejde

Publikation: Bidrag til tidsskriftArtikelForskningpeer review

Abstract

BACKGROUND: Inhaled corticosteroids (ICS) are associated with an increased risk of clinical pneumonia among patients with chronic obstructive pulmonary disease (COPD). It is unknown whether the risk of microbiologically verified pneumonia such as pneumococcal pneumonia is increased in ICS users.

METHODS: The study population consists of all COPD patients followed in outpatient clinics in eastern Denmark during 2010-2017. ICS use was categorized into four categories based on accumulated use. A Cox proportional hazard regression model was used adjusting for age, body mass index, sex, airflow limitation, use of oral corticosteroids, smoking, and year of cohort entry. A propensity score matched analysis was performed for sensitivity analyses.

FINDINGS: A total of 21,438 patients were included. Five hundred and eighty-two (2.6%) patients acquired a positive lower airway tract sample with S. pneumoniae during follow-up. In the multivariable analysis ICS-use was associated with a dose-dependent risk of S. pneumoniae as follows: low ICS dose: HR 1.11, 95% CI 0.84 to 1.45, p = 0.5; moderate ICS dose: HR 1.47, 95% CI 1.13 to 1.90, p = 0.004; high ICS dose: HR 1.77, 95% CI 1.38 to 2.29, p < 0.0001, compared to no ICS use. Sensitivity analyses confirmed these results.

INTERPRETATION: Use of ICS in patients with severe COPD was associated with an increased and dose-dependent risk of acquiring S. pneumoniae, but only for moderate and high dose. Caution should be taken when administering high dose of ICS to patients with COPD. Low dose of ICS seemed not to carry this risk.

OriginalsprogEngelsk
Sider (fra-til)373-384
Antal sider12
TidsskriftInternational Journal of COPD
Vol/bind18
DOI
StatusUdgivet - 2023

Bibliografisk note

© 2023 Heerfordt et al.

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