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

Abstract

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.

Complicated bacterial lung infections in patients with COPD

“…Indtil videre er der evidens for, at der er tale om en klasseeffekt, og at risikoen er uafhaengig af typen af glukokortikoid, og om der bruges pulver eller spray. I et nyligt publiceret studie har man dog påvist, at risikoen for pneumoni var mindre hos patienter, der brugte ICS med ekstrafine partikler, end hos patienter, der brugte almindelig partikelstørrelse [23]. Rygestop er vist at kunne reducere risikoen for indlaeggelseskraevende eksacerbationer med naesten 20% sammenlignet med patienter med KOL, der ikke ophører med tobaksrygning, og risikoreduktionen stiger i takt med tiden siden rygestop [24].…”

Inhaled Corticosteroids in Subjects with Chronic Obstructive Pulmonary Disease: An Old, Unfinished History

“…This property is particularly important because the Diskus ® and Ellipta ® inhalers, releasing fluticasone propionate and furoate, respectively, have lower drug lung delivery than those delivering budesonide and BDP [77]. These latter devices produce finer aerosols (said extra-fine aerosols) that have been associated with improved inhaler techniques and reduced risks of pneumonia hospitalization [87,88]. However, apart from greater drug lung deposition, it is not fully known if extra-fine aerosols can effectively assure improved outcomes in COPD.…”