Observational Study of Inhaled Corticosteroids on Outcomes for COPD Patients with Pneumonia

Abstract

Rationale: Treatment with inhaled corticosteroids (ICS) for those with chronic obstructive pulmonary disease (COPD) has been shown to be associated with an increased incidence of pneumonia. However, it is unclear if this is associated with increased mortality. Objectives: The aim of this study was to examine the effects of prior use of ICS on clinical outcomes for patients with COPD hospitalized with pneumonia. Methods: We conducted a retrospective cohort study using the national administrative databases of the Department of Veterans Affairs. Eligible patients had a preexisting diagnosis of COPD, had a discharge diagnosis of pneumonia, and received treatment with one or more appropriate pulmonary medications before hospitalization. Outcomes included mortality, use of invasive mechanical ventilation, and vasopressor use. Conclusions: For patients with COPD, prior use of ICS is independently associated with decreased risk of short-term mortality and use of mechanical ventilation after hospitalization for pneumonia.Keywords: inhaled corticosteroids; pneumonia; chronic obstructive pulmonary disease; mortality Chronic obstructive pulmonary disease (COPD) is the fourth most frequent cause of chronic morbidity and mortality in developed countries (1). One of the current recommended COPD treatments by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) is inhaled corticosteroids (ICS) for symptomatic patients with a documented bronchodilator response on spirometry or for patients with FEV 1 less than 50% predicted, which is indicative of moderate-to-severe COPD (2). Although ICS treatment reduces the overall frequency of exacerbations of COPD (3), evidence suggests that ICS treatment is associated with an increased risk of pneumonia (4-6).Despite several studies demonstrating that patients with COPD have an increased likelihood of developing pneumonia when receiving ICS (4-8), it remains unclear if use of ICS is associated with adverse medical outcomes for patients with COPD. Prior studies examining the effect of COPD on pneumonia-related mortality have led to conflicting conclusions (9-11). Two systematic reviews examining the use of ICS therapy to manage COPD found no significant differences in mortality (4, 5). Another study comparing COPD exacerbation rates between patients being treated with either salmeterol or a combination of salmeterol and fluticasone demonstrated that all-cause mortality was similar for patients hospitalized with pneumonia regardless of prior use of ICS (6). However, they did find increased mortality for users of ICS with pneumonia within 30 days of hospitalization. Another recent study showed that use of ICS was associated with lower 30-and 90-day mortality after pneumonia; however, this study was not able to examine other clinically relevant outcomes or assess the effects of other appropriate respiratory medications received (12).The aim of our study was to examine the association between prior use of ICS and clinical outcomes, including mortality, need Studies demonstrate that...

Severity and outcomes of hospitalised community-acquired pneumonia in COPD patients

“…Thus, we cannot discard the possibility that previous administration of ICS is not only a ''marker of COPD'', but that it may reduce lung inflammatory response resulting in fewer pulmonary complications [22]. In concordance with this hypothesis, different authors have clearly suggested that ICS could diminish CAP severity by modulating the local inflammatory response (lung microenvironment and macrophage activation) [23] and subsequent organ dysfunction [24,25] and, possibly, could even reduce mortality rate [26,27]. Our data do not confirm an association of ICS with mortality, but the observed protective effect against pulmonary complications clearly confirms the hypothesis of a positive influence of ICS on CAP severity.…”

Study on Steroid Utilization Pattern in a Tertiary Care Teaching Hospital

“…This is supported by a study conducted by Dennis Chen et al carried out in south Texas who reported 47.7% of their patients to be smokers. 12 The major clinical complaints of the patients admitted in general medicine were related to Respiratory Tract (59.32%) followed by Dermatological complaints (33.18%), Skeletal (5%), Blood Vessel (0.88%) and Neurological (0.88%) which was similar to study done by SanojVarkey et al in pulmonary department, 13 TP VanStaa et al who conducted the study in general medicine department 14 and a study done in Maharashtra by Wahane Pravin kumar et al who conducted the study in dermatology department. 15 Non-infectious skin diseases like psoriasis topped the Table by 29.33%, followed by Eczema (16%), Pemphigus Vulgaris (8%).…”

Inhaled Corticosteroids Do Not Influence the Early Inflammatory Response and Clinical Presentation of Hospitalized Subjects With COPD Exacerbation

“…Although the use of inhaled corticosteroids in COPD patients has been demonstrated to be useful in the reduction of exacerbation events 16,17 and in protection against the development of complicated forms of hospitalized community-acquired pneumonia. 14,15 On the other hand, the long-term use of inhaled corticosteroids increases the risk of pneumonia, [18][19][20] especially with fluticasone. 20 Our study, performed in subjects with COPD exacerbation but without pneumonia, demonstrates that inhaled corticosteroids have no detrimental effect on the development of complications on admission or in other outcomes collected during the clinical course.…”