Inhaled corticosteroids in COPD and the risk of serious pneumonia
Identifieur interne : 001134 ( Main/Exploration ); précédent : 001133; suivant : 001135Inhaled corticosteroids in COPD and the risk of serious pneumonia
Auteurs : Samy Suissa [Canada] ; Valérie Patenaude [Canada] ; Francesco Lapi [Canada] ; Pierre Ernst [Canada]Source :
- 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
Affiliations:
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Institute, Jewish General Hospital, McGill University, Montreal, Québec</wicri:regionArea><orgName type="university">Université McGill</orgName><placeName><settlement type="city">Montréal</settlement><region type="state">Québec</region></placeName></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><affiliations><list><country><li>Canada</li></country><region><li>Québec</li></region><settlement><li>Montréal</li></settlement><orgName><li>Université McGill</li></orgName></list><tree><country name="Canada"><region name="Québec"><name sortKey="Suissa, Samy" sort="Suissa, Samy" uniqKey="Suissa S" first="Samy" last="Suissa">Samy Suissa</name></region><name sortKey="Ernst, Pierre" sort="Ernst, Pierre" uniqKey="Ernst P" first="Pierre" last="Ernst">Pierre Ernst</name><name sortKey="Lapi, Francesco" sort="Lapi, Francesco" uniqKey="Lapi F" first="Francesco" last="Lapi">Francesco Lapi</name><name sortKey="Patenaude, Valerie" sort="Patenaude, Valerie" uniqKey="Patenaude V" first="Valérie" last="Patenaude">Valérie Patenaude</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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