&lt;p&gt;Clinical and Economic Consequences of Inhaled Corticosteroid Doses and Particle Size in Triple Inhalation Therapy for COPD: Real-Life Study&lt;/p&gt;

Sicras‐Mainar, Antoni; Abajo, Francisco J. de; Izquierdo, José Luis

doi:10.2147/copd.s281333

Cited by 5 publications

(7 citation statements)

References 31 publications

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“…Another study examined the effectiveness of extrafine particles compared with standard size particles and did not show differences in the risk of pneumonia, however, they only found very few cases of pneumonia (four confirmed) 18. Similarly, one-third study showed no difference in incidence of pneumonia for patients with COPD receiving triple therapy with or without extrafine particle ICS, although based on few outcomes 19…”

Section: Discussionmentioning

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: 99%

“… 18 Similarly, one-third study showed no difference in incidence of pneumonia for patients with COPD receiving triple therapy with or without extrafine particle ICS, although based on few outcomes. 19 …”

Section: Discussionmentioning

confidence: 99%

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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“…These results are similar to some available evidence, although controlled studies are required to improve decision making on the use of ICS in clinical practice. 7 , 8 , 37 , 38 …”

Section: Discussionmentioning

confidence: 99%

“…These results are similar to some available evidence, although controlled studies are required to improve decision making on the use of ICS in clinical practice. 7,8,37,38 The corrected mean health cost per patient/year of ICS withdrawal compared with continuing triple therapy was higher (€2993 vs €2130). These results are directly related to the proportion of exacerbations, particularly severe exacerbations requiring hospitalization.…”

Section: Discussionmentioning

confidence: 99%

Clinical and Economic Impact of Long-Term Inhaled Corticosteroid Withdrawal in Patients with Chronic Obstructive Pulmonary Disease Treated with Triple Therapy in Spain

García¹,

Vallejo-Aparicio²,

Ismaila³

et al. 2022

COPD

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Purpose To determine the clinical and economic impact of inhaled corticosteroid (ICS) withdrawal in Spanish patients with COPD receiving triple therapy (TT) with ICS, long-acting β 2 -agonist (LABA), and long-acting muscarinic antagonist (LAMA). Patients and Methods This was an observational, retrospective study of BIG-PAC database medical records. Patients aged ≥40 years receiving TT from 2016 to 2018 were followed for 1 year. Two cohorts were identified: patients continuing TT (ICS+LABA+LAMA), and patients receiving TT with ICS withdrawn (LABA+LAMA). Variables included medication, exacerbations (moderate and severe), pneumonia, mortality, health resource use (HRU), and cost per patient/year. Cohorts were compared using propensity score matching (PSM). Multivariate statistical analysis using analysis of covariance and Cox proportional risks was conducted. Results Of 6541 patients included, 5740 (87.8%) continued TT and 801 (12.2%) had ICS withdrawn. Patients with ICS withdrawal were younger, had lower disease burden, higher ICS doses, and more exacerbations compared with those continuing ICS. PSM matched 795 patients in each cohort. Mean age was 68.5 years (SD: 11.2), 69.9% were male, and mean Charlson index was 2.0. Patients with ICS withdrawal had more total exacerbations in the 12 months following withdrawal compared with patients continuing TT (36.6% vs 31.4%; p=0.030). No significant differences were found for pneumonia (3.3% vs 3.6%; p=0.583) and mortality (9.9% vs 7.5%; p=0.092). Median time to first exacerbation was shorter in patients with ICS withdrawal compared with those continuing ICS (HR: 0.69, 95% CI: 0.57–0.83; p<0.001). Mean health cost per patient/year among patients with ICS withdrawal was higher than those continuing TT (€2993 vs €2130; p<0.001). Conclusion ICS withdrawal in patients with COPD receiving TT was associated with increased exacerbations, HRU, and costs compared with continuing TT, with health and economic impacts on patients and the Spanish National Healthcare System, respectively. Pneumonia and mortality rates were similar between groups.

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“…68 Some studies have shown benefit from inhaled corticosteroids in cGVHD patients with obstructive airway disease. 69,70 However, this benefit must be balanced by recent data pointing toward an increased risk of pneumonia 71 and nontuberculous mycobacterial infection 72 in patients with chronic obstruction pulmonary disease who receive inhaled corticosteroids. For patients with life-threatening pulmonary cGVHD, lung transplantation is performed with similar survival at 1, 3, and 5 years as matched controls with other end-stage lung diseases.…”

Section: Secondary Immunodeficiencies Chronic Graft Versus Host Diseasementioning

confidence: 99%

Common Variable Immunodeficiency and Other Immunodeficiency Syndromes in Bronchiectasis

McShane

2021

Semin Respir Crit Care Med

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Immunodeficiency represents a vast number of diseases and syndromes. Both primary and secondary forms of immunodeficiency are important contributors to the development of bronchiectasis. Primary immune deficiencies, in particular, are increasingly identified and defined as contributors. Specific immune deficiencies that are closely associated with bronchiectasis and as discussed in this article are common variable immunodeficiency, specific antibody deficiency, immunodeficiencies involving immunoglobulin E, DOCK8 immunodeficiency, phosphoglucomutase 3 deficiency, activated phosphoinositide 3-kinase delta syndrome, and X-linked agammaglobulinemia. Each of these primary immune deficiencies has unique nuances. Vigilance for these unique signs and symptoms is likely to improve recognition of specific immunodeficiency in the idiopathic bronchiectasis patient. Secondary forms of immunodeficiency occur as a result of a separate disease process. Graft versus host disease, malignancy, and human immunodeficiency virus are three classic examples discussed in this article. An awareness of the potential for these disease settings to lead to bronchiectasis is necessary to optimize patient care. With understanding and mindfulness toward the intricate relationship between bronchiectasis and immunodeficiency, there is an opportunity to elucidate pathophysiologic underpinnings between these two syndromes.

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<p>Clinical and Economic Consequences of Inhaled Corticosteroid Doses and Particle Size in Triple Inhalation Therapy for COPD: Real-Life Study</p>

Cited by 5 publications

References 31 publications

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

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

Clinical and Economic Impact of Long-Term Inhaled Corticosteroid Withdrawal in Patients with Chronic Obstructive Pulmonary Disease Treated with Triple Therapy in Spain

Common Variable Immunodeficiency and Other Immunodeficiency Syndromes in Bronchiectasis

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