The Effect of Inhaled Corticosteroids on Pneumonia Risk in Patients With COPD-Bronchiectasis Overlap : A UK Population-Based Case-Control Study
Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved..
BACKGROUND: Inhaled corticosteroids (ICS) increase the risk of pneumonia in COPD and commonly are used in patients with COPD-bronchiectasis overlap.
RESEARCH QUESTION: Is the risk of pneumonia associated with ICS further heightened in COPD-bronchiectasis?.
STUDY DESIGN AND METHODS: Electronic health care records (from 2004-2019) were used to obtain a cohort of patients with COPD and a nested case-control group (age and sex matched 1:4). Analyses were conducted to determine the risk of hospitalization for pneumonia in COPD associated with ICS use in those with bronchiectasis. Findings were confirmed by several sensitivity analyses. Additionally, a smaller nested case-control group containing only patients with COPD-bronchiectasis overlap and those with recent blood eosinophil counts (BECs) was used to determine any association with BEC.
RESULTS: Three hundred sixteen thousand six hundred sixty-three patients were eligible for the COPD cohort; bronchiectasis significantly increased the risk of pneumonia (adjusted hazard ratio, 1.24; 95% CI, 1.15-1.33). In the first nested case-control group of 84,316 patients with COPD, ICS was found to increase the odds of pneumonia (adjusted OR [AOR], 1.26; 95% CI, 1.19-1.32) only if used in the previous 180 days. However, bronchiectasis was a significant modifier such that ICS use did not augment further the already elevated bronchiectasis-associated pneumonia risk (COPD-bronchiectasis: AOR, 1.01; 95% CI, 0.8-1.28; no bronchiectasis: AOR, 1.27; 95% CI, 1.20-1.34). Several sensitivity analyses and a second smaller nested case-control group confirmed these findings. Finally, we found that BEC modified the ICS-associated pneumonia risk in COPD-bronchiectasis overlap, where lower BEC was associated significantly with pneumonia (BEC ≤ 3 × 109/L: AOR, 1.56; 95% CI, 1.05-2.31; BEC > 3 × 109/L: AOR, 0.89; 95% CI, 0.53-1.24).
INTERPRETATION: ICS use does not augment further the already increased risk of hospitalization for pneumonia associated with concomitant bronchiectasis in patients with COPD.
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:164 |
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| Enthalten in: |
Chest - 164(2023), 4 vom: 06. Okt., Seite 875-884 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Ritchie, Andrew I [VerfasserIn] |
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| Links: |
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| Themen: |
Bronchiectasis |
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| Anmerkungen: |
Date Completed 16.10.2023 Date Revised 20.03.2024 published: Print-Electronic CommentIn: Chest. 2023 Oct;164(4):809-811. - PMID 37805235 Citation Status MEDLINE |
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| doi: |
10.1016/j.chest.2023.06.007 |
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NLM359202055 |
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| 100 | 1 | |a Ritchie, Andrew I |e verfasserin |4 aut | |
| 245 | 1 | 4 | |a The Effect of Inhaled Corticosteroids on Pneumonia Risk in Patients With COPD-Bronchiectasis Overlap |b A UK Population-Based Case-Control Study |
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| 500 | |a CommentIn: Chest. 2023 Oct;164(4):809-811. - PMID 37805235 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved. | ||
| 520 | |a BACKGROUND: Inhaled corticosteroids (ICS) increase the risk of pneumonia in COPD and commonly are used in patients with COPD-bronchiectasis overlap | ||
| 520 | |a RESEARCH QUESTION: Is the risk of pneumonia associated with ICS further heightened in COPD-bronchiectasis? | ||
| 520 | |a STUDY DESIGN AND METHODS: Electronic health care records (from 2004-2019) were used to obtain a cohort of patients with COPD and a nested case-control group (age and sex matched 1:4). Analyses were conducted to determine the risk of hospitalization for pneumonia in COPD associated with ICS use in those with bronchiectasis. Findings were confirmed by several sensitivity analyses. Additionally, a smaller nested case-control group containing only patients with COPD-bronchiectasis overlap and those with recent blood eosinophil counts (BECs) was used to determine any association with BEC | ||
| 520 | |a RESULTS: Three hundred sixteen thousand six hundred sixty-three patients were eligible for the COPD cohort; bronchiectasis significantly increased the risk of pneumonia (adjusted hazard ratio, 1.24; 95% CI, 1.15-1.33). In the first nested case-control group of 84,316 patients with COPD, ICS was found to increase the odds of pneumonia (adjusted OR [AOR], 1.26; 95% CI, 1.19-1.32) only if used in the previous 180 days. However, bronchiectasis was a significant modifier such that ICS use did not augment further the already elevated bronchiectasis-associated pneumonia risk (COPD-bronchiectasis: AOR, 1.01; 95% CI, 0.8-1.28; no bronchiectasis: AOR, 1.27; 95% CI, 1.20-1.34). Several sensitivity analyses and a second smaller nested case-control group confirmed these findings. Finally, we found that BEC modified the ICS-associated pneumonia risk in COPD-bronchiectasis overlap, where lower BEC was associated significantly with pneumonia (BEC ≤ 3 × 109/L: AOR, 1.56; 95% CI, 1.05-2.31; BEC > 3 × 109/L: AOR, 0.89; 95% CI, 0.53-1.24) | ||
| 520 | |a INTERPRETATION: ICS use does not augment further the already increased risk of hospitalization for pneumonia associated with concomitant bronchiectasis in patients with COPD | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a COPD | |
| 650 | 4 | |a bronchiectasis | |
| 650 | 4 | |a inhaled corticosteroid | |
| 650 | 4 | |a pneumonia | |
| 650 | 7 | |a Glucocorticoids |2 NLM | |
| 700 | 1 | |a Singayagam, Aran |e verfasserin |4 aut | |
| 700 | 1 | |a Mitchell, Sebastian |e verfasserin |4 aut | |
| 700 | 1 | |a Wedzicha, Jadwiga A |e verfasserin |4 aut | |
| 700 | 1 | |a Shah, Anand |e verfasserin |4 aut | |
| 700 | 1 | |a Bloom, Chloë I |e verfasserin |4 aut | |
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