TY - JOUR
T1 - Use of inhaled corticosteroids and risk of acquiring Pseudomonas aeruginosa in patients with chronic obstructive pulmonary disease
AU - Eklöf, Josefin
AU - Ingebrigtsen, Truls Sylvan
AU - Sørensen, Rikke
AU - Saeed, Mohamad Isam
AU - Alispahic, Imane Achir
AU - Sivapalan, Pradeesh
AU - Boel, Jonas Bredtoft
AU - Bangsborg, Jette
AU - Ostergaard, Christian
AU - Dessau, Ram Benny
AU - Jensen, Ulrich Stab
AU - Hansen, Ejvind Frausing
AU - Lapperre, Therese Sophie
AU - Meteran, Howraman
AU - Wilcke, Torgny
AU - Seersholm, Niels
AU - Jensen, Jens-Ulrik Stæhr
N1 - © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
PY - 2022/6
Y1 - 2022/6
N2 - BACKGROUND: Inhaled corticosteroids (ICS) are commonly used to treat COPD and are associated with increased risk of pneumonia. The aim of this study was to assess if accumulated use of ICS is associated with a dose-dependent risk of a positive airway culture with Pseudomonas aeruginosa in patients with COPD.METHODS: We conducted a multiregional epidemiological cohort study including Danish COPD patients followed in outpatient clinics during 2010-2017. ICS use was categorised based on accumulated prescriptions redeemed 365 days prior to cohort entry. Cox proportional hazard regression model was used to estimate the risk of acquiring P. aeruginosa. Propensity score matched models were used as sensitivity analyses.RESULTS: A total of 21 408 patients were included in the study, of which 763 (3.6%) acquired P. aeruginosa during follow-up. ICS use was associated with a dose-dependent risk of P. aeruginosa (low ICS dose: HR 1.38, 95% CI 1.03 to 1.84, p=0.03; moderate ICS dose: HR 2.16, 95% CI 1.63 to 2.85, p<0.0001; high ICS dose: HR 3.58, 95% CI 2.75 to 4.65, p<0.0001; reference: no ICS use). A propensity matched model confirmed the results (high ICS dose compared with no/low/moderate ICS dose: HR 2.05, 95% CI 1.76 to 2.39, p p<0.0001).CONCLUSION: Use of ICS in patients with COPD followed in Danish outpatient clinics was associated with a substantially increased and dose-dependent risk of acquiring P. aeruginosa. Caution should be taken when administering high doses of ICS in severely ill patients with COPD. These results should be confirmed in comparable cohorts and other settings.
AB - BACKGROUND: Inhaled corticosteroids (ICS) are commonly used to treat COPD and are associated with increased risk of pneumonia. The aim of this study was to assess if accumulated use of ICS is associated with a dose-dependent risk of a positive airway culture with Pseudomonas aeruginosa in patients with COPD.METHODS: We conducted a multiregional epidemiological cohort study including Danish COPD patients followed in outpatient clinics during 2010-2017. ICS use was categorised based on accumulated prescriptions redeemed 365 days prior to cohort entry. Cox proportional hazard regression model was used to estimate the risk of acquiring P. aeruginosa. Propensity score matched models were used as sensitivity analyses.RESULTS: A total of 21 408 patients were included in the study, of which 763 (3.6%) acquired P. aeruginosa during follow-up. ICS use was associated with a dose-dependent risk of P. aeruginosa (low ICS dose: HR 1.38, 95% CI 1.03 to 1.84, p=0.03; moderate ICS dose: HR 2.16, 95% CI 1.63 to 2.85, p<0.0001; high ICS dose: HR 3.58, 95% CI 2.75 to 4.65, p<0.0001; reference: no ICS use). A propensity matched model confirmed the results (high ICS dose compared with no/low/moderate ICS dose: HR 2.05, 95% CI 1.76 to 2.39, p p<0.0001).CONCLUSION: Use of ICS in patients with COPD followed in Danish outpatient clinics was associated with a substantially increased and dose-dependent risk of acquiring P. aeruginosa. Caution should be taken when administering high doses of ICS in severely ill patients with COPD. These results should be confirmed in comparable cohorts and other settings.
KW - Administration, Inhalation
KW - Adrenal Cortex Hormones/adverse effects
KW - Bronchodilator Agents/therapeutic use
KW - Cohort Studies
KW - Humans
KW - Pseudomonas aeruginosa
KW - Pulmonary Disease, Chronic Obstructive
KW - COPD epidemiology
KW - respiratory infection
UR - http://www.scopus.com/inward/record.url?scp=85121261780&partnerID=8YFLogxK
U2 - 10.1136/thoraxjnl-2021-217160
DO - 10.1136/thoraxjnl-2021-217160
M3 - Journal article
C2 - 34446524
VL - 77
SP - 573
EP - 580
JO - Thorax
JF - Thorax
SN - 0040-6376
IS - 6
M1 - 217160
ER -