Use of Inhaled Corticosteroids and Risk of Acquiring Haemophilus influenzae in Patients with Chronic Obstructive Pulmonary Disease

Raza Ul Mohsin*, Christian Kjer Heerfordt, Josefin Eklöf, Pradeesh Sivapalan, Mohamad Isam Saeed, Truls Sylvan Ingebrigtsen, Susanne Dam Nielsen, Zitta Barrella Harboe, Kasper Karmark Iversen, Jette M. Bangsborg, Jens Otto Jarløv, Jonas Bredtoft Boel, Christian Østergaard Andersen, Henrik Pierre Calum, Ram B Dessau, Jens-Ulrik Stæhr Jensen

*Corresponding author af dette arbejde

Publikation: Bidrag til tidsskriftArtikelForskningpeer review

Abstract

Background: Inhaled corticosteroids (ICS) are widely used in chronic obstructive pulmonary disease (COPD), despite the known risk of severe adverse effects including pulmonary infections. Research Question: Our study investigates the risk of acquiring a positive Haemophilus influenzae airway culture with use of ICS in outpatients with COPD. Study Design and Methods: We conducted an epidemiological cohort study using data from 1 January 2010 to 19 February 2018, including 21,218 outpatients with COPD in Denmark. ICS use 365 days prior to cohort entry was categorised into low, moderate, and high, based on cumulated ICS dose extracted from a national registry on reimbursed prescriptions. A Cox proportional hazards regression model was used to assess the future risk of acquiring H. Influenzae within 365 days from cohort entry, and sensitivity analyses were performed using propensity score matched models. Results: In total, 801 (3.8%) patients acquired H. Influenzae during follow-up. Use of ICS was associated with a dose-dependent increased risk of acquiring H. Influenzae with hazard ratio (HR) 1.2 (95% confidence interval (CI) 0.9-1.5, p value = 0.1) for low-dose ICS; HR 1.7 (95% CI 1.3-2.1, p value < 0.0001) for moderate dose; and HR 1.9 (95% CI 1.5-2.4, p value < 0.0001) for high-dose ICS compared to no ICS use. Results were confirmed in the propensity-matched model using the same categories. Conclusions: ICS use in outpatients with COPD was associated with a dose-dependent increase in risk of isolating H. Influenzae. This observation supports that high dose ICS should be used with caution.

OriginalsprogEngelsk
TidsskriftJournal of Clinical Medicine
Vol/bind11
Udgave nummer12
DOI
StatusUdgivet - 20 jun. 2022

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