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Hvidovre Hospital - a part of Copenhagen University Hospital
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Use of inhaled corticosteroids and risk of acquiring Pseudomonas aeruginosa in patients with chronic obstructive pulmonary disease

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  1. Acute exacerbations of chronic obstructive pulmonary disease: in search of diagnostic biomarkers and treatable traits

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  4. Airflow limitation in people living with HIV and matched uninfected controls

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  1. Persistence and genetic adaptation of Pseudomonas aeruginosa in patients with chronic obstructive pulmonary disease

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  2. Risk of Malignancy in Patients with Asthma‐COPD Overlap Compared to Patients with COPD without Asthma

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

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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.

Original languageEnglish
Article number217160
JournalThorax
Volume77
Issue number6
Pages (from-to)573-580
Number of pages8
ISSN0040-6376
DOIs
Publication statusPublished - Jun 2022

    Research areas

  • Administration, Inhalation, Adrenal Cortex Hormones/adverse effects, Bronchodilator Agents/therapeutic use, Cohort Studies, Humans, Pseudomonas aeruginosa, Pulmonary Disease, Chronic Obstructive, COPD epidemiology, respiratory infection

ID: 67443840