TY - JOUR
T1 - Inhaled Corticosteroids in Patients with Chronic Obstructive Pulmonary Disease and Risk of Acquiring Streptococcus pneumoniae Infection. A Multiregional Epidemiological Study
AU - Heerfordt, Christian Kjer
AU - Eklöf, Josefin
AU - Sivapalan, Pradeesh
AU - Ingebrigtsen, Truls Sylvan
AU - Biering-Sørensen, Tor
AU - Harboe, Zitta Barrella
AU - Koefod Petersen, Jesper
AU - Andersen, Christian Østergaard
AU - Boel, Jonas Bredtoft
AU - Bock, Anne Kathrine
AU - Mathioudakis, Alexander G
AU - Hurst, John R
AU - Kolekar, Shailesh
AU - Johansson, Sofie Lock
AU - Bangsborg, Jette Marie
AU - Jarløv, Jens Otto
AU - Dessau, Ram Benny
AU - Laursen, Christian Borbjerg
AU - Perch, Michael
AU - Jensen, Jens-Ulrik Stæhr
N1 - © 2023 Heerfordt et al.
PY - 2023
Y1 - 2023
N2 - 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.
AB - 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.
KW - Humans
KW - Pulmonary Disease, Chronic Obstructive/diagnosis
KW - Administration, Inhalation
KW - Pneumonia/chemically induced
KW - Adrenal Cortex Hormones/adverse effects
KW - Pneumococcal Infections/diagnosis
KW - Epidemiologic Studies
U2 - 10.2147/COPD.S386518
DO - 10.2147/COPD.S386518
M3 - Article
C2 - 36974273
SN - 1176-9106
VL - 18
SP - 373
EP - 384
JO - International Journal of COPD
JF - International Journal of COPD
ER -