The Effect of Inhaled Corticosteroids on Pneumonia Risk in Patients With COPD-Bronchiectasis Overlap

Ritchie, Andrew I.; Singanayagam, Aran; Mitchell, Sebastian; Wedzicha, Jadwiga A.; Shah, Anand; Bloom, Chloë I.

doi:10.1016/j.chest.2023.06.007

Cited by 3 publications

(2 citation statements)

References 37 publications

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“…A very recent retrospective study carried out using electronic health care records in the USA has been the only one to analyze the risk of hospitalization for pneumonia in patients with BCOS and treatment with ICs. This study concluded that the use of ICs did not further increase the already increased risk of bronchiectasis in patients with BCOS, but that in the subgroup study, this risk only appeared in those patients who were taking ICs and had less than 300 eosinophils µL and not in those with eosinophilia [42]. In this respect, the results of this study concur with ours in not observing an increase in the risk of pneumonia after taking ICs, although it was observed in patients with a reduction in the number of eosinophils, regardless of whether or not they took ICs.…”

Section: Discussionmentioning

confidence: 77%

Bronchiectasis-COPD Overlap Syndrome: Role of Peripheral Eosinophil Count and Inhaled Corticosteroid Treatment

Oscullo,

Gómez-Olivas,

Ingles

et al. 2023

JCM

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Both chronic obstructive pulmonary disease and bronchiectasis are highly prevalent diseases. In both cases, inhaled corticosteroids (ICs) are associated with a decrease in exacerbations in patients with a high peripheral blood eosinophil count (BEC), but it is still not known what occurs in bronchiectasis-COPD overlap syndrome (BCOS). The present study aimed to assess the effect of ICs on various outcomes in patients with BCOS, according to BEC values. We undertook a post-hoc analysis of a cohort of 201 GOLD II-IV COPD patients with a long-term follow-up (median 74 [IQR: 40–106] months). All participants underwent computerized tomography and 115 (57.2%) had confirmed BCOS. A standardized clinical protocol was followed and two sputum samples were collected at each medical visit (every 3–6 months), whenever possible. During follow-up, there were 68 deaths (59.1%), and the mean rate of exacerbations and hospitalizations per year was 1.42 (1.2) and 0.57 (0.83), respectively. A total of 44.3% of the patients presented at least one pneumonic episode per year. The mean value of eosinophils was 402 (112) eosinophils/µL, with 27 (23.5%), 63 (54.8%), and 25 patients (21.7%) presenting, respectively, less than 100, 101–300, and more than 300 eosinophils/µL. A total of 84 patients (73.1%) took ICs. The higher the BEC, the higher the annual rate of exacerbations and hospitalizations. Patients with less than 100 eosinophils/µL presented more infectious events (incident exacerbations, pneumonic episodes, and chronic bronchial infection via pathogenic bacteria). Only those patients with eosinophilia (>300 eosinophils/µL) treated with ICs decreased the number (1.77 (1.2) vs. 1.08 (0.6), p < 0.001) and the severity (0.67 (0.8) vs. 0.35 (0.5), p = 0.011) of exacerbations, without any changes in the other infectious outcomes or mortality. In conclusion, ICs treatment in patients with BCOS with increased BEC decreased the number and severity of incident exacerbations without any negative influence on other infectious outcomes (incidence of pneumonia or chronic bronchial infection).

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Section: Discussionmentioning

confidence: 77%

Bronchiectasis-COPD Overlap Syndrome: Role of Peripheral Eosinophil Count and Inhaled Corticosteroid Treatment

Oscullo,

Gómez-Olivas,

Ingles

et al. 2023

JCM

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“…The prevalence of bronchiectasis is higher than that expected in patients with asthma or COPD (28,29). In addition to asthma-COPD overlap, overlap of asthma or COPD with bronchiectasis has also been described (30,31). Bronchiectasis shares molecular mechanisms with asthma and COPD, including neutrophilic and eosinophilic inflammation, allergen sensitization, altered airway microbiota, and mucociliary and neutrophil dysfunction (32).…”

Section: Chronic Obstructive Airway Diseasesmentioning

confidence: 99%

Clinical Benefits of Targeting Treatable Traits in Asthma and Chronic Obstructive Pulmonary Disease

Morishima,

Hizawa

2024

Intern. Med.

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Asthma and chronic obstructive pulmonary disease (COPD) have long been debated regarding their similarities and differences in clinical presentation and pathology. There has also been a discussion about how common therapeutics should be used differently for each disease. Traditionally, a "one size fits all" stepwise treatment has been chosen based on the severity of each case after categorizing the diseases, such as asthma or COPD. However, recently, the need for a precise approach for the treatment of individual patients beyond the disease category has been emphasized, especially in severe cases. To achieve precise personalized therapy, it has become necessary to focus on the individual phenotypes and underlying causal molecular mechanisms (endotypes) and to identify key therapeutic targets, which are called treatable traits. This review discusses the evidence for the importance of identifying treatable traits and therapeutic strategies based on the broader perspective of chronic obstructive airway disease rather than on individual diseases such as asthma or COPD.

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Inhaled Corticosteroids in COPD and Bronchiectasis

Chalmers,

Shoemark

2023

CHEST

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The Effect of Inhaled Corticosteroids on Pneumonia Risk in Patients With COPD-Bronchiectasis Overlap

Cited by 3 publications

References 37 publications

Bronchiectasis-COPD Overlap Syndrome: Role of Peripheral Eosinophil Count and Inhaled Corticosteroid Treatment

Bronchiectasis-COPD Overlap Syndrome: Role of Peripheral Eosinophil Count and Inhaled Corticosteroid Treatment

Clinical Benefits of Targeting Treatable Traits in Asthma and Chronic Obstructive Pulmonary Disease

Inhaled Corticosteroids in COPD and Bronchiectasis

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