Risk of Haemophilus Influenzae Infection in Patients with Chronic Obstructive Pulmonary Disease Using Inhaled Corticosteroids: A Cohort Study of 23,789 Outpatients

Inhaled corticosteroids (ICS) are widely used in chronic obstructive pulmonary disease (COPD) treatment, despite known risk of pulmonary infections. We investigated the risk of aquiring a Haemophilus influenzae (HI) positive airway culture in ICS users, by conduncting an epidemological cohort study from 1.1.2010 to 18.2.2018, including 23,789 Danish COPD outpatients.ICS use 365 days prior to cohort entry was categorised into low, moderate, and high based on accumulated ICS dose extracted from reimbursed prescriptions. Cox proportional hazards regression model was used to assess the future risk of acquiring HI within 365 days from cohort entry and sensitivity analyses were done using propensity score matched models.670 (2.8%) patients acquired HI during follow-up. Use of ICS was associated with dose dependent increased risk of acquiring HI (low dose: Hazard Ratio (HR) 1.3, 95% confidence interval (CI) 1-1.7, p-value (p)=0.02; moderate dose: HR 1.9, CI 1.5-2.4, p=<.0001;High dose HR 2.4 CI 1.9-2.9 p<.0001 reference: no ICS use). Results were confirmed in propensity matched model (high/moderate vs low/no ICS use: HR 1.4, CI 1.44-1.44, p<.0001). So ICS use in COPD outpateints was associated with significant dose dependent increase in risk of acquiring HI. Clinical assessment of benefits vs risk of infection should be made before prescription of ICS. FootnotesCite this article as: European Respiratory Journal 2021; 58: Suppl. 65, PA2412.This abstract was presented at the 2021 ERS International Congress, in session “Prediction of exacerbations in patients with COPD”.This is an ERS International Congress abstract. No full-text version is available. Further material to accompany this abstract may be available at www.ers-education.org (ERS member access only).