Hospitalization for chronic obstructive pulmonary disease and pneumonia: association with the dose of inhaled corticosteroids. A nation-wide cohort study of 52 100 outpatients

Rønn, Christian; Sivapalan, Pradeesh; Eklöf, Josefin; Kamstrup, Peter; Bonnesen, Barbara; Harboe, Zitta Barrella; Browatzki, Andrea; Kjaergaard, J; Meyer, Christian; Jensen, Troels Mygind; Johansson, Sofie Lock; Bendstrup, Elisabeth; Ulrik, Charlotte Suppli; Jensen, Jens‐Ulrik Stæhr

doi:10.1016/j.cmi.2022.11.029

Cited by 7 publications

(9 citation statements)

References 26 publications

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“…Previous studies have indicated a possible excess risk of pneumonia associated with fluticasone 21. However, when accounting for dose equivalency, such associations to fluticasone cannot be reproduced, and the biological correlate to such a notion seems less clear 4. While our study cohort consisted of patients with COPD followed in outpatient clinics by pulmonologists, treated with ICS, we believe that the influence of particle size on pneumonia risk is likely to hold relevance across broader COPD patient populations.…”

Section: Discussionmentioning

confidence: 90%

“…21 However, when accounting for dose equivalency, such associations to fluticasone cannot be reproduced, and the biological correlate to such a notion seems less clear. 4 While our study cohort consisted of patients with COPD followed in outpatient clinics by pulmonologists, treated with ICS, we believe that the influence of particle size on pneumonia risk is likely to hold relevance across broader COPD patient populations. However, caution should be exercised when generalising our findings to patients with COPD followed by general practitioners, as they may Open access exhibit lower pneumonia hospitalisation rates.…”

Section: Discussionmentioning

confidence: 99%

“…While ICS has been shown to reduce COPD exacerbation rates through its anti-inflammatory effects,1 it has also been associated with an increased risk of several side effects, including pneumonia, most probably due to its immunosuppressive effects 2 3. Mounting evidence suggests that the risk of pneumonia in patients with COPD treated with ICS increases in a dose-dependent manner 4 5…”

Section: Introductionmentioning

confidence: 99%

“… 2 3 Mounting evidence suggests that the risk of pneumonia in patients with COPD treated with ICS increases in a dose-dependent manner. 4 5 …”

Section: Introductionmentioning

confidence: 99%

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Inhalation devices and inhaled corticosteroids particle size influence on severe pneumonia in patients with chronic obstructive pulmonary disease: a nationwide cohort study

Heerfordt,

Rønn,

Harboe

et al. 2023

BMJ Open Resp Res

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BackgroundInhaled corticosteroids (ICSs) are associated with an increased risk of pneumonia among patients with chronic obstructive pulmonary disease (COPD). The introduction of extrafine particle ICS has aimed to improve the distribution of medicine in the airways by altering deposition within the lungs, potentially affecting efficacy and side effects. It remains unclear if extrafine particle ICS administration alters the risk of pneumonia compared with standard particle size ICS.MethodsAn observational cohort study including all Danish COPD outpatients receiving ICS from 2010 to 2017. The primary outcome was pneumonia hospitalisation in the different ICS particle dosing regimens. The primary analysis was an adjusted Cox proportional hazards model. For sensitivity analysis, a subgroup analysis of patients receiving spray devices was done. Further, we created a propensity score matched cohort, in which we matched for the same covariates as adjusted for in the main analysis.ResultsA total of 35 691 patients were included of whom 1471 received extrafine particle ICS. Among these patients, 4657 were hospitalised due to pneumonia. Patients with COPD receiving extrafine particle ICS had a lower risk of hospitalisation due to pneumonia compared with patients receiving standard particle size ICS in our primary analysis (HR 0.75; 95% CI 0.63 to 0.89; p=0.002), subgroup analysis (HR 0.54; 95% CI 0.45 to 0.65; p<0.0001) and the propensity-matched population (HR 0.72; 95% CI 0.60 to 0.87; p=0.0006).InterpretationThe use of extrafine particle ICS administration was associated with a lower risk of pneumonia hospitalisation in patients with COPD compared with those who received standard size treatment.

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“… 2 3 Mounting evidence suggests that the risk of pneumonia in patients with COPD treated with ICS increases in a dose-dependent manner. 4 5 …”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Inhalation devices and inhaled corticosteroids particle size influence on severe pneumonia in patients with chronic obstructive pulmonary disease: a nationwide cohort study

Heerfordt,

Rønn,

Harboe

et al. 2023

BMJ Open Resp Res

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“…flere nyere opgørelser, at ICS fortsat udskrives til over halvdelen af patienter med KOL i såvel Danmark som internationalt [15]. Studier har vist, at der er en kontinuerlig sammenhaeng mellem eosinofilocyttal i blodet og effekt af ICS hos patienter med KOL; sparsom eller ingen effekt ved vaerdier < 0,1 × 10 9 celler/l, og størst effekt ses ved vaerdier ≥ 0,3 × 10 9 celler/l.…”

Section: Ugeskrift For Laeger Ugeskrift For Laegerunclassified

Complicated bacterial lung infections in patients with COPD

Eklöf,

Sivapalan,

Jensen

2024

Ugeskr Læger

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Patients with COPD are at increased risk of lung infections. Specific pathogens, including Pseudomonas aeruginosa, are associated with severe exacerbations requiring hospitalisation and death. New research summarised in this review highlights the importance of inhaled corticosteroids as a risk factor for lung infections. Reduction and discontinuation of treatment should be considered in patients with frequent or persistent infections. Long-term treatment with azithromycin and inhaled antibiotics may effectively reduce severe exacerbations in COPD.

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