Inhaled corticosteroids in COPD and the risk of serious pneumonia
Identifieur interne : 002969 ( Istex/Corpus ); précédent : 002968; suivant : 002970Inhaled corticosteroids in COPD and the risk of serious pneumonia
Auteurs : Samy Suissa ; Valérie Patenaude ; Francesco Lapi ; Pierre ErnstSource :
- Thorax [ 0040-6376 ] ; 2013-11.
English descriptors
- Teeft :
- Agonist, Antirheumatic drugs, Asthma, Beclomethasone, Budesonide, Cohort, Cohort entry, Copd, Copd exacerbations, Copd hospitalisation, Corticosteroid, Cubic splines model, Current users, Daily dose, Database, Dos, Epidemiology, Fluticasone, High doses, Hospitalisation, Index date, Inhaled, Inhaled corticosteroid, Inhaled corticosteroids, Lower dose, Lower risk, Medication, Oral corticosteroids, Osteoporosis drugs, Pneumonia, Prescription, Primary diagnosis, Pulmonary disease, Rate ratio, Rate ratios, Respir, Respir crit care, Respiratory disease, Respiratory drugs, Respiratory medications, Serious pneumonia, Suissa, System drugs, Systematic review, Thorax, Tiotropium bromide, Uticasone, Uticasone equivalents, Uticasone propionate.
Abstract
Background Inhaled corticosteroids (ICS) are known to increase the risk of pneumonia in patients with chronic obstructive pulmonary disease (COPD). It is unclear whether the risk of pneumonia varies for different inhaled agents, particularly fluticasone and budesonide, and increases with the dose and long-term duration of use. Methods We formed a new-user cohort of patients with COPD treated during 1990–2005. Subjects were identified using the Quebec health insurance databases and followed through 2007 or until a serious pneumonia event, defined as a first hospitalisation for or death from pneumonia. A nested case–control analysis was used to estimate the rate ratio (RR) of serious pneumonia associated with current ICS use, adjusted for age, sex, respiratory disease severity and comorbidity. Results The cohort included 163 514 patients, of which 20 344 had a serious pneumonia event during the 5.4 years of follow-up (incidence rate 2.4/100/year). Current use of ICS was associated with a 69% increase in the rate of serious pneumonia (RR 1.69; 95% CI 1.63 to 1.75). The risk was sustained with long-term use and declined gradually after stopping ICS use, disappearing after 6 months (RR 1.08; 95% CI 0.99 to 1.17). The rate of serious pneumonia was higher with fluticasone (RR 2.01; 95% CI 1.93 to 2.10), increasing with the daily dose, but was much lower with budesonide (RR 1.17; 95% CI 1.09 to 1.26). Conclusions ICS use by patients with COPD increases the risk of serious pneumonia. The risk is particularly elevated and dose related with fluticasone. While residual confounding cannot be ruled out, the results are consistent with those from recent randomised trials.
Url:
DOI: 10.1136/thoraxjnl-2012-202872
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ISTEX:4E6CE91D2B7E4404500A289CF7C32C19818F5D01Le document en format XML
<record><TEI wicri:istexFullTextTei="biblStruct"><teiHeader><fileDesc><titleStmt><title>Inhaled corticosteroids in COPD and the risk of serious pneumonia</title><author><name sortKey="Suissa, Samy" sort="Suissa, Samy" uniqKey="Suissa S" first="Samy" last="Suissa">Samy Suissa</name><affiliation><mods:affiliation>Departments of Epidemiology and Biostatistics and of Medicine, Center for Clinical Epidemiology, Lady Davis Research Institute, Jewish General Hospital, McGill University, Montreal, Québec, Canada</mods:affiliation></affiliation></author><author><name sortKey="Patenaude, Valerie" sort="Patenaude, Valerie" uniqKey="Patenaude V" first="Valérie" last="Patenaude">Valérie Patenaude</name><affiliation><mods:affiliation>Departments of Epidemiology and Biostatistics and of Medicine, Center for Clinical Epidemiology, Lady Davis Research Institute, Jewish General Hospital, McGill University, Montreal, Québec, Canada</mods:affiliation></affiliation></author><author><name sortKey="Lapi, Francesco" sort="Lapi, Francesco" uniqKey="Lapi F" first="Francesco" last="Lapi">Francesco Lapi</name><affiliation><mods:affiliation>Departments of Epidemiology and Biostatistics and of Medicine, Center for Clinical Epidemiology, Lady Davis Research Institute, Jewish General Hospital, McGill University, Montreal, Québec, Canada</mods:affiliation></affiliation></author><author><name sortKey="Ernst, Pierre" sort="Ernst, Pierre" uniqKey="Ernst P" first="Pierre" last="Ernst">Pierre Ernst</name><affiliation><mods:affiliation>Departments of Epidemiology and Biostatistics and of Medicine, Center for Clinical Epidemiology, Lady Davis Research Institute, Jewish General Hospital, McGill University, Montreal, Québec, Canada</mods:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">ISTEX</idno><idno type="RBID">ISTEX:4E6CE91D2B7E4404500A289CF7C32C19818F5D01</idno><date when="2013" year="2013">2013</date><idno 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Patenaude</name><affiliation><mods:affiliation>Departments of Epidemiology and Biostatistics and of Medicine, Center for Clinical Epidemiology, Lady Davis Research Institute, Jewish General Hospital, McGill University, Montreal, Québec, Canada</mods:affiliation></affiliation></author><author><name sortKey="Lapi, Francesco" sort="Lapi, Francesco" uniqKey="Lapi F" first="Francesco" last="Lapi">Francesco Lapi</name><affiliation><mods:affiliation>Departments of Epidemiology and Biostatistics and of Medicine, Center for Clinical Epidemiology, Lady Davis Research Institute, Jewish General Hospital, McGill University, Montreal, Québec, Canada</mods:affiliation></affiliation></author><author><name sortKey="Ernst, Pierre" sort="Ernst, Pierre" uniqKey="Ernst P" first="Pierre" last="Ernst">Pierre Ernst</name><affiliation><mods:affiliation>Departments of Epidemiology and Biostatistics and of Medicine, Center for Clinical Epidemiology, Lady Davis Research Institute, Jewish General Hospital, McGill University, Montreal, Québec, Canada</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j">Thorax</title><title level="j" type="abbrev">Thorax</title><idno type="ISSN">0040-6376</idno><idno type="eISSN">1468-3296</idno><imprint><publisher>BMJ Publishing Group Ltd and British Thoracic Society</publisher><date type="published" when="2013-11">2013-11</date><biblScope unit="volume">68</biblScope><biblScope unit="issue">11</biblScope><biblScope unit="page" from="1029">1029</biblScope></imprint><idno type="ISSN">0040-6376</idno></series></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0040-6376</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="Teeft" xml:lang="en"><term>Agonist</term><term>Antirheumatic drugs</term><term>Asthma</term><term>Beclomethasone</term><term>Budesonide</term><term>Cohort</term><term>Cohort entry</term><term>Copd</term><term>Copd exacerbations</term><term>Copd hospitalisation</term><term>Corticosteroid</term><term>Cubic splines model</term><term>Current users</term><term>Daily dose</term><term>Database</term><term>Dos</term><term>Epidemiology</term><term>Fluticasone</term><term>High doses</term><term>Hospitalisation</term><term>Index date</term><term>Inhaled</term><term>Inhaled corticosteroid</term><term>Inhaled corticosteroids</term><term>Lower dose</term><term>Lower risk</term><term>Medication</term><term>Oral corticosteroids</term><term>Osteoporosis drugs</term><term>Pneumonia</term><term>Prescription</term><term>Primary diagnosis</term><term>Pulmonary disease</term><term>Rate ratio</term><term>Rate ratios</term><term>Respir</term><term>Respir crit care</term><term>Respiratory disease</term><term>Respiratory drugs</term><term>Respiratory medications</term><term>Serious pneumonia</term><term>Suissa</term><term>System drugs</term><term>Systematic review</term><term>Thorax</term><term>Tiotropium bromide</term><term>Uticasone</term><term>Uticasone equivalents</term><term>Uticasone propionate</term></keywords></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract">Background Inhaled corticosteroids (ICS) are known to increase the risk of pneumonia in patients with chronic obstructive pulmonary disease (COPD). It is unclear whether the risk of pneumonia varies for different inhaled agents, particularly fluticasone and budesonide, and increases with the dose and long-term duration of use. Methods We formed a new-user cohort of patients with COPD treated during 1990–2005. Subjects were identified using the Quebec health insurance databases and followed through 2007 or until a serious pneumonia event, defined as a first hospitalisation for or death from pneumonia. A nested case–control analysis was used to estimate the rate ratio (RR) of serious pneumonia associated with current ICS use, adjusted for age, sex, respiratory disease severity and comorbidity. Results The cohort included 163 514 patients, of which 20 344 had a serious pneumonia event during the 5.4 years of follow-up (incidence rate 2.4/100/year). Current use of ICS was associated with a 69% increase in the rate of serious pneumonia (RR 1.69; 95% CI 1.63 to 1.75). The risk was sustained with long-term use and declined gradually after stopping ICS use, disappearing after 6 months (RR 1.08; 95% CI 0.99 to 1.17). The rate of serious pneumonia was higher with fluticasone (RR 2.01; 95% CI 1.93 to 2.10), increasing with the daily dose, but was much lower with budesonide (RR 1.17; 95% CI 1.09 to 1.26). Conclusions ICS use by patients with COPD increases the risk of serious pneumonia. The risk is particularly elevated and dose related with fluticasone. While residual confounding cannot be ruled out, the results are consistent with those from recent randomised trials.</div></front></TEI><istex><corpusName>bmj</corpusName><keywords><teeft><json:string>copd</json:string><json:string>uticasone</json:string><json:string>budesonide</json:string><json:string>inhaled</json:string><json:string>corticosteroid</json:string><json:string>serious pneumonia</json:string><json:string>cohort</json:string><json:string>hospitalisation</json:string><json:string>index date</json:string><json:string>suissa</json:string><json:string>pneumonia</json:string><json:string>respir</json:string><json:string>pulmonary disease</json:string><json:string>inhaled corticosteroids</json:string><json:string>epidemiology</json:string><json:string>dos</json:string><json:string>database</json:string><json:string>fluticasone</json:string><json:string>thorax</json:string><json:string>high doses</json:string><json:string>asthma</json:string><json:string>beclomethasone</json:string><json:string>rate ratio</json:string><json:string>agonist</json:string><json:string>cohort entry</json:string><json:string>respiratory medications</json:string><json:string>lower risk</json:string><json:string>respir crit care</json:string><json:string>oral corticosteroids</json:string><json:string>antirheumatic drugs</json:string><json:string>primary diagnosis</json:string><json:string>inhaled corticosteroid</json:string><json:string>medication</json:string><json:string>tiotropium bromide</json:string><json:string>system drugs</json:string><json:string>osteoporosis drugs</json:string><json:string>copd exacerbations</json:string><json:string>copd hospitalisation</json:string><json:string>respiratory drugs</json:string><json:string>uticasone equivalents</json:string><json:string>lower dose</json:string><json:string>rate ratios</json:string><json:string>cubic splines model</json:string><json:string>daily dose</json:string><json:string>current users</json:string><json:string>uticasone propionate</json:string><json:string>respiratory disease</json:string><json:string>systematic review</json:string><json:string>prescription</json:string></teeft></keywords><author><json:item><name>Samy Suissa</name><affiliations><json:string>Departments of Epidemiology and Biostatistics and of Medicine, Center for Clinical Epidemiology, Lady Davis Research Institute, Jewish General Hospital, McGill University, Montreal, Québec, Canada</json:string></affiliations></json:item><json:item><name>Valérie Patenaude</name><affiliations><json:string>Departments of Epidemiology and Biostatistics and of Medicine, Center for Clinical Epidemiology, Lady Davis Research Institute, Jewish General Hospital, McGill University, Montreal, Québec, Canada</json:string></affiliations></json:item><json:item><name>Francesco Lapi</name><affiliations><json:string>Departments of Epidemiology and Biostatistics and of Medicine, Center for Clinical Epidemiology, Lady Davis Research Institute, Jewish General Hospital, McGill University, Montreal, Québec, Canada</json:string></affiliations></json:item><json:item><name>Pierre Ernst</name><affiliations><json:string>Departments of Epidemiology and Biostatistics and of Medicine, Center for Clinical Epidemiology, Lady Davis Research Institute, Jewish General Hospital, McGill University, Montreal, Québec, Canada</json:string></affiliations></json:item></author><articleId><json:string>thoraxjnl-2012-202872</json:string></articleId><arkIstex>ark:/67375/NVC-G9QL6536-T</arkIstex><language><json:string>eng</json:string></language><originalGenre><json:string>research-article</json:string></originalGenre><abstract>Background Inhaled corticosteroids (ICS) are known to increase the risk of pneumonia in patients with chronic obstructive pulmonary disease (COPD). It is unclear whether the risk of pneumonia varies for different inhaled agents, particularly fluticasone and budesonide, and increases with the dose and long-term duration of use. Methods We formed a new-user cohort of patients with COPD treated during 1990–2005. Subjects were identified using the Quebec health insurance databases and followed through 2007 or until a serious pneumonia event, defined as a first hospitalisation for or death from pneumonia. A nested case–control analysis was used to estimate the rate ratio (RR) of serious pneumonia associated with current ICS use, adjusted for age, sex, respiratory disease severity and comorbidity. Results The cohort included 163 514 patients, of which 20 344 had a serious pneumonia event during the 5.4 years of follow-up (incidence rate 2.4/100/year). Current use of ICS was associated with a 69% increase in the rate of serious pneumonia (RR 1.69; 95% CI 1.63 to 1.75). The risk was sustained with long-term use and declined gradually after stopping ICS use, disappearing after 6 months (RR 1.08; 95% CI 0.99 to 1.17). The rate of serious pneumonia was higher with fluticasone (RR 2.01; 95% CI 1.93 to 2.10), increasing with the daily dose, but was much lower with budesonide (RR 1.17; 95% CI 1.09 to 1.26). Conclusions ICS use by patients with COPD increases the risk of serious pneumonia. The risk is particularly elevated and dose related with fluticasone. While residual confounding cannot be ruled out, the results are consistent with those from recent randomised trials.</abstract><qualityIndicators><score>10</score><pdfWordCount>5104</pdfWordCount><pdfCharCount>33729</pdfCharCount><pdfVersion>1.3</pdfVersion><pdfPageCount>8</pdfPageCount><pdfPageSize>595.276 x 793.701 pts</pdfPageSize><refBibsNative>true</refBibsNative><abstractWordCount>261</abstractWordCount><abstractCharCount>1685</abstractCharCount><keywordCount>0</keywordCount></qualityIndicators><title>Inhaled corticosteroids in COPD and the risk of serious pneumonia</title><pmid><json:string>24130228</json:string></pmid><genre><json:string>research-article</json:string></genre><host><title>Thorax</title><language><json:string>unknown</json:string></language><issn><json:string>0040-6376</json:string></issn><eissn><json:string>1468-3296</json:string></eissn><publisherId><json:string>thorax</json:string></publisherId><volume>68</volume><issue>11</issue><pages><first>1029</first></pages><genre><json:string>journal</json:string></genre><subject><json:item><value>Open access</value></json:item></subject></host><namedEntities><unitex><date><json:string>1000</json:string><json:string>2013</json:string><json:string>7000</json:string><json:string>1990</json:string><json:string>1029</json:string><json:string>1996</json:string></date><geogName></geogName><orgName><json:string>Lady Davis Research Institute, Jewish General Hospital</json:string><json:string>National Asthma Education Expert</json:string><json:string>Research Ethics Committee of the Jewish General Hospital, Montreal, Quebec, Canada</json:string><json:string>National Asthma and Prevention Program</json:string><json:string>Canada Correspondence</json:string><json:string>Canadian Foundation for Innovation</json:string><json:string>Commission</json:string><json:string>CIHR</json:string><json:string>Canadian Institutes of Health Research</json:string></orgName><orgName_funder><json:string>Canadian Foundation for Innovation</json:string><json:string>Commission</json:string><json:string>CIHR</json:string><json:string>Canadian Institutes of Health Research</json:string></orgName_funder><orgName_provider></orgName_provider><persName><json:string>Francesco Lapi</json:string><json:string>Samy Suissa</json:string><json:string>Ernst Departments</json:string><json:string>Valérie Patenaude</json:string><json:string>Panel</json:string></persName><placeName><json:string>Montreal</json:string><json:string>Canada</json:string><json:string>Quebec</json:string></placeName><ref_url><json:string>http://dx.doi.org/</json:string><json:string>http://creativecommons.org/ licenses/by-nc/</json:string></ref_url><ref_bibl></ref_bibl><bibl></bibl></unitex></namedEntities><ark><json:string>ark:/67375/NVC-G9QL6536-T</json:string></ark><categories><wos><json:string>1 - science</json:string><json:string>2 - respiratory system</json:string></wos><scienceMetrix><json:string>1 - health sciences</json:string><json:string>2 - clinical medicine</json:string><json:string>3 - respiratory system</json:string></scienceMetrix><scopus><json:string>1 - Health Sciences</json:string><json:string>2 - Medicine</json:string><json:string>3 - Pulmonary and Respiratory Medicine</json:string></scopus><inist><json:string>1 - sciences appliquees, technologies et medecines</json:string><json:string>2 - sciences biologiques et medicales</json:string><json:string>3 - sciences medicales</json:string></inist></categories><publicationDate>2013</publicationDate><copyrightDate>2013</copyrightDate><doi><json:string>10.1136/thoraxjnl-2012-202872</json:string></doi><id>4E6CE91D2B7E4404500A289CF7C32C19818F5D01</id><score>1</score><fulltext><json:item><extension>pdf</extension><original>true</original><mimetype>application/pdf</mimetype><uri>https://api.istex.fr/ark:/67375/NVC-G9QL6536-T/fulltext.pdf</uri></json:item><json:item><extension>zip</extension><original>false</original><mimetype>application/zip</mimetype><uri>https://api.istex.fr/ark:/67375/NVC-G9QL6536-T/bundle.zip</uri></json:item><istex:fulltextTEI uri="https://api.istex.fr/ark:/67375/NVC-G9QL6536-T/fulltext.tei"><teiHeader><fileDesc><titleStmt><title level="a">Inhaled corticosteroids in COPD and the risk of serious pneumonia</title></titleStmt><publicationStmt><authority>ISTEX</authority><publisher scheme="https://publisher-list.data.istex.fr">BMJ Publishing Group Ltd and British Thoracic Society</publisher><availability status="free"><p>Open Access</p></availability><date>2013</date></publicationStmt><notesStmt><note type="research-article" scheme="https://content-type.data.istex.fr/ark:/67375/XTP-1JC4F85T-7">research-article</note><note type="journal" scheme="https://publication-type.data.istex.fr/ark:/67375/JMC-0GLKJH51-B">journal</note></notesStmt><sourceDesc><biblStruct type="inbook"><analytic><title level="a">Inhaled corticosteroids in COPD and the risk of serious pneumonia</title><author xml:id="author-0000"><persName><forename type="first">Samy</forename><surname>Suissa</surname></persName><affiliation>Departments of Epidemiology and Biostatistics and of Medicine, Center for Clinical Epidemiology, Lady Davis Research Institute, Jewish General Hospital, McGill University, Montreal, Québec, Canada</affiliation></author><author xml:id="author-0001"><persName><forename type="first">Valérie</forename><surname>Patenaude</surname></persName><affiliation>Departments of Epidemiology and Biostatistics and of Medicine, Center for Clinical Epidemiology, Lady Davis Research Institute, Jewish General Hospital, McGill University, Montreal, Québec, Canada</affiliation></author><author xml:id="author-0002"><persName><forename type="first">Francesco</forename><surname>Lapi</surname></persName><affiliation>Departments of Epidemiology and Biostatistics and of Medicine, Center for Clinical Epidemiology, Lady Davis Research Institute, Jewish General Hospital, McGill University, Montreal, Québec, Canada</affiliation></author><author xml:id="author-0003"><persName><forename type="first">Pierre</forename><surname>Ernst</surname></persName><affiliation>Departments of Epidemiology and Biostatistics and of Medicine, Center for Clinical Epidemiology, Lady Davis Research Institute, Jewish General Hospital, McGill University, Montreal, Québec, Canada</affiliation></author><idno type="istex">4E6CE91D2B7E4404500A289CF7C32C19818F5D01</idno><idno type="ark">ark:/67375/NVC-G9QL6536-T</idno><idno type="DOI">10.1136/thoraxjnl-2012-202872</idno><idno type="href">thoraxjnl-68-1029.pdf</idno><idno type="article-id">thoraxjnl-2012-202872</idno><idno type="Related-article-href">10.1136/thoraxjnl-2012-202709</idno><idno type="Related-article-href">10.1136/thoraxjnl-2012-202959</idno><idno type="related-article-ID">RA1</idno><idno type="local">thoraxjnl;68/11/1029</idno></analytic><monogr><title level="j">Thorax</title><title level="j" type="abbrev">Thorax</title><idno type="pISSN">0040-6376</idno><idno type="eISSN">1468-3296</idno><idno type="publisher-id">thorax</idno><idno type="PublisherID-hwp">thoraxjnl</idno><idno type="PublisherID-nlm-ta">Thorax</idno><imprint><publisher>BMJ Publishing Group Ltd and British Thoracic Society</publisher><date type="published" when="2013-11"></date><biblScope unit="volume">68</biblScope><biblScope unit="issue">11</biblScope><biblScope unit="page" from="1029">1029</biblScope></imprint></monogr></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>2013</date></creation><langUsage><language ident="en">en</language></langUsage><abstract><p>Background Inhaled corticosteroids (ICS) are known to increase the risk of pneumonia in patients with chronic obstructive pulmonary disease (COPD). It is unclear whether the risk of pneumonia varies for different inhaled agents, particularly fluticasone and budesonide, and increases with the dose and long-term duration of use. Methods We formed a new-user cohort of patients with COPD treated during 1990–2005. Subjects were identified using the Quebec health insurance databases and followed through 2007 or until a serious pneumonia event, defined as a first hospitalisation for or death from pneumonia. A nested case–control analysis was used to estimate the rate ratio (RR) of serious pneumonia associated with current ICS use, adjusted for age, sex, respiratory disease severity and comorbidity. Results The cohort included 163 514 patients, of which 20 344 had a serious pneumonia event during the 5.4 years of follow-up (incidence rate 2.4/100/year). Current use of ICS was associated with a 69% increase in the rate of serious pneumonia (RR 1.69; 95% CI 1.63 to 1.75). The risk was sustained with long-term use and declined gradually after stopping ICS use, disappearing after 6 months (RR 1.08; 95% CI 0.99 to 1.17). The rate of serious pneumonia was higher with fluticasone (RR 2.01; 95% CI 1.93 to 2.10), increasing with the daily dose, but was much lower with budesonide (RR 1.17; 95% CI 1.09 to 1.26). Conclusions ICS use by patients with COPD increases the risk of serious pneumonia. The risk is particularly elevated and dose related with fluticasone. While residual confounding cannot be ruled out, the results are consistent with those from recent randomised trials.</p></abstract><textClass><keywords scheme="Journal Subject"><list><head>hwp-journal-coll</head><item><term>Open access</term></item></list></keywords></textClass></profileDesc><revisionDesc><change when="2013-11">Published</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><extension>txt</extension><original>false</original><mimetype>text/plain</mimetype><uri>https://api.istex.fr/ark:/67375/NVC-G9QL6536-T/fulltext.txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="corpus bmj" wicri:toSee="no header"><istex:xmlDeclaration>version="1.0" encoding="UTF-8" standalone="no"</istex:xmlDeclaration><istex:docType PUBLIC="-//NLM//DTD Journal Archiving and Interchange DTD v2.3 20070202//EN" URI="archivearticle.dtd" name="istex:docType"></istex:docType><istex:document><article article-type="research-article"><front><journal-meta><journal-id journal-id-type="hwp">thoraxjnl</journal-id><journal-id journal-id-type="nlm-ta">Thorax</journal-id><journal-id journal-id-type="publisher-id">thorax</journal-id><journal-title>Thorax</journal-title><abbrev-journal-title abbrev-type="publisher">Thorax</abbrev-journal-title><abbrev-journal-title>Thorax</abbrev-journal-title><issn pub-type="ppub">0040-6376</issn><issn pub-type="epub">1468-3296</issn><publisher><publisher-name>BMJ Publishing Group Ltd and British Thoracic Society</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="publisher-id">thoraxjnl-2012-202872</article-id><article-id pub-id-type="doi">10.1136/thoraxjnl-2012-202872</article-id><article-id pub-id-type="other">thoraxjnl;68/11/1029</article-id><article-id pub-id-type="other">thoraxjnl;thoraxjnl-2012-202872</article-id><article-id pub-id-type="other">1029</article-id><article-id pub-id-type="other">thoraxjnl-2012-202872</article-id><article-categories><subj-group subj-group-type="heading"><subject>Epidemiology</subject></subj-group><subj-group subj-group-type="hwp-journal-coll"><subject>Open access</subject></subj-group><series-title>Original article</series-title></article-categories><title-group><article-title>Inhaled corticosteroids in COPD and the risk of serious pneumonia</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Suissa</surname><given-names>Samy</given-names></name></contrib><contrib contrib-type="author"><name><surname>Patenaude</surname><given-names>Valérie</given-names></name></contrib><contrib contrib-type="author"><name><surname>Lapi</surname><given-names>Francesco</given-names></name></contrib><contrib contrib-type="author"><name><surname>Ernst</surname><given-names>Pierre</given-names></name></contrib></contrib-group><aff><addr-line>Departments of Epidemiology and Biostatistics and of Medicine</addr-line>, <institution>Center for Clinical Epidemiology, Lady Davis Research Institute, Jewish General Hospital, McGill University</institution>, <addr-line>Montreal, Québec</addr-line>, <country>Canada</country></aff><author-notes><corresp><label>Correspondence to</label> Prof Samy Suissa, Centre for Clinical Epidemiology, Jewish General Hospital, 3755 Cote Ste-Catherine, Montreal, Québec, Canada H3T 1E2; <email>samy.suissa@mcgill.ca</email></corresp></author-notes><pub-date pub-type="ppub"><month>11</month><year>2013</year></pub-date><volume>68</volume><volume-id pub-id-type="other">68</volume-id><volume-id pub-id-type="other">68</volume-id><issue>11</issue><issue-id pub-id-type="other">thoraxjnl;68/11</issue-id><issue-id pub-id-type="other">11</issue-id><issue-id pub-id-type="other">68/11</issue-id><fpage>1029</fpage><history><date date-type="received"><day>14</day><month>10</month><year>2012</year></date><date date-type="rev-recd"><day>16</day><month>8</month><year>2013</year></date><date date-type="accepted"><day>25</day><month>8</month><year>2013</year></date></history><permissions><copyright-statement>Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions</copyright-statement><copyright-year>2013</copyright-year><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/"><p><bold>Open Access</bold> This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: <ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by-nc/3.0/">http://creativecommons.org/licenses/by-nc/3.0/</ext-link></p></license></permissions><self-uri content-type="pdf" xlink:role="full-text" xlink:href="thoraxjnl-68-1029.pdf"></self-uri><related-article id="RA1" related-article-type="companion" ext-link-type="doi" xlink:href="10.1136/thoraxjnl-2012-202709"></related-article><related-article id="RA2" related-article-type="companion" ext-link-type="doi" xlink:href="10.1136/thoraxjnl-2012-202959"></related-article><abstract><sec><title>Background</title><p>Inhaled corticosteroids (ICS) are known to increase the risk of pneumonia in patients with chronic obstructive pulmonary disease (COPD). It is unclear whether the risk of pneumonia varies for different inhaled agents, particularly fluticasone and budesonide, and increases with the dose and long-term duration of use.</p></sec><sec><title>Methods</title><p>We formed a new-user cohort of patients with COPD treated during 1990–2005. Subjects were identified using the Quebec health insurance databases and followed through 2007 or until a serious pneumonia event, defined as a first hospitalisation for or death from pneumonia. A nested case–control analysis was used to estimate the rate ratio (RR) of serious pneumonia associated with current ICS use, adjusted for age, sex, respiratory disease severity and comorbidity.</p></sec><sec><title>Results</title><p>The cohort included 163 514 patients, of which 20 344 had a serious pneumonia event during the 5.4 years of follow-up (incidence rate 2.4/100/year). Current use of ICS was associated with a 69% increase in the rate of serious pneumonia (RR 1.69; 95% CI 1.63 to 1.75). The risk was sustained with long-term use and declined gradually after stopping ICS use, disappearing after 6 months (RR 1.08; 95% CI 0.99 to 1.17). The rate of serious pneumonia was higher with fluticasone (RR 2.01; 95% CI 1.93 to 2.10), increasing with the daily dose, but was much lower with budesonide (RR 1.17; 95% CI 1.09 to 1.26).</p></sec><sec><title>Conclusions</title><p>ICS use by patients with COPD increases the risk of serious pneumonia. The risk is particularly elevated and dose related with fluticasone. While residual confounding cannot be ruled out, the results are consistent with those from recent randomised trials.</p></sec></abstract></article-meta></front></article></istex:document></istex:metadataXml><mods version="3.6"><titleInfo><title>Inhaled corticosteroids in COPD and the risk of serious pneumonia</title><partName>Original article</partName></titleInfo><titleInfo type="alternative" contentType="CDATA"><title>Inhaled corticosteroids in COPD and the risk of serious pneumonia</title><partName>Original article</partName></titleInfo><name type="personal"><namePart type="given">Samy</namePart><namePart type="family">Suissa</namePart><affiliation>Departments of Epidemiology and Biostatistics and of Medicine, Center for Clinical Epidemiology, Lady Davis Research Institute, Jewish General Hospital, McGill University, Montreal, Québec, Canada</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Valérie</namePart><namePart type="family">Patenaude</namePart><affiliation>Departments of Epidemiology and Biostatistics and of Medicine, Center for Clinical Epidemiology, Lady Davis Research Institute, Jewish General Hospital, McGill University, Montreal, Québec, Canada</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Francesco</namePart><namePart type="family">Lapi</namePart><affiliation>Departments of Epidemiology and Biostatistics and of Medicine, Center for Clinical Epidemiology, Lady Davis Research Institute, Jewish General Hospital, McGill University, Montreal, Québec, Canada</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Pierre</namePart><namePart type="family">Ernst</namePart><affiliation>Departments of Epidemiology and Biostatistics and of Medicine, Center for Clinical Epidemiology, Lady Davis Research Institute, Jewish General Hospital, McGill University, Montreal, Québec, Canada</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="research-article" displayLabel="research-article" authority="ISTEX" authorityURI="https://content-type.data.istex.fr" valueURI="https://content-type.data.istex.fr/ark:/67375/XTP-1JC4F85T-7">research-article</genre><originInfo><publisher>BMJ Publishing Group Ltd and British Thoracic Society</publisher><dateIssued encoding="w3cdtf">2013-11</dateIssued><copyrightDate encoding="w3cdtf">2013</copyrightDate></originInfo><language><languageTerm type="code" authority="iso639-2b">eng</languageTerm><languageTerm type="code" authority="rfc3066">en</languageTerm></language><abstract>Background Inhaled corticosteroids (ICS) are known to increase the risk of pneumonia in patients with chronic obstructive pulmonary disease (COPD). It is unclear whether the risk of pneumonia varies for different inhaled agents, particularly fluticasone and budesonide, and increases with the dose and long-term duration of use. Methods We formed a new-user cohort of patients with COPD treated during 1990–2005. Subjects were identified using the Quebec health insurance databases and followed through 2007 or until a serious pneumonia event, defined as a first hospitalisation for or death from pneumonia. A nested case–control analysis was used to estimate the rate ratio (RR) of serious pneumonia associated with current ICS use, adjusted for age, sex, respiratory disease severity and comorbidity. Results The cohort included 163 514 patients, of which 20 344 had a serious pneumonia event during the 5.4 years of follow-up (incidence rate 2.4/100/year). Current use of ICS was associated with a 69% increase in the rate of serious pneumonia (RR 1.69; 95% CI 1.63 to 1.75). The risk was sustained with long-term use and declined gradually after stopping ICS use, disappearing after 6 months (RR 1.08; 95% CI 0.99 to 1.17). The rate of serious pneumonia was higher with fluticasone (RR 2.01; 95% CI 1.93 to 2.10), increasing with the daily dose, but was much lower with budesonide (RR 1.17; 95% CI 1.09 to 1.26). Conclusions ICS use by patients with COPD increases the risk of serious pneumonia. The risk is particularly elevated and dose related with fluticasone. While residual confounding cannot be ruled out, the results are consistent with those from recent randomised trials.</abstract><relatedItem type="host"><titleInfo><title>Thorax</title></titleInfo><titleInfo type="abbreviated"><title>Thorax</title></titleInfo><genre type="journal" authority="ISTEX" authorityURI="https://publication-type.data.istex.fr" valueURI="https://publication-type.data.istex.fr/ark:/67375/JMC-0GLKJH51-B">journal</genre><subject><genre>hwp-journal-coll</genre><topic>Open access</topic></subject><identifier type="ISSN">0040-6376</identifier><identifier type="eISSN">1468-3296</identifier><identifier type="PublisherID">thorax</identifier><identifier type="PublisherID-hwp">thoraxjnl</identifier><identifier type="PublisherID-nlm-ta">Thorax</identifier><part><date>2013</date><detail type="volume"><caption>vol.</caption><number>68</number></detail><detail type="issue"><caption>no.</caption><number>11</number></detail><extent unit="pages"><start>1029</start></extent></part></relatedItem><relatedItem type="reviewOf"><identifier type="doi">10.1136/thoraxjnl-2012-202709</identifier></relatedItem><relatedItem type="reviewOf"><identifier type="doi">10.1136/thoraxjnl-2012-202959</identifier></relatedItem><identifier type="istex">4E6CE91D2B7E4404500A289CF7C32C19818F5D01</identifier><identifier type="ark">ark:/67375/NVC-G9QL6536-T</identifier><identifier type="DOI">10.1136/thoraxjnl-2012-202872</identifier><identifier type="href">thoraxjnl-68-1029.pdf</identifier><identifier type="ArticleID">thoraxjnl-2012-202872</identifier><identifier type="Related-article-href">10.1136/thoraxjnl-2012-202709</identifier><identifier type="Related-article-href">10.1136/thoraxjnl-2012-202959</identifier><identifier type="related-article-ID">RA1</identifier><identifier type="local">thoraxjnl;68/11/1029</identifier><accessCondition type="use and reproduction" contentType="open-access">Open Access This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. 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