Inhalation devices and inhaled corticosteroids particle size influence on severe pneumonia in patients with chronic obstructive pulmonary disease : a nationwide cohort study
© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ..
BACKGROUND: Inhaled 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.
METHODS: An 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.
RESULTS: A 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).
INTERPRETATION: The 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.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:10 |
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| Enthalten in: |
BMJ open respiratory research - 10(2023), 1 vom: 29. Sept. |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Heerfordt, Christian Kjer [VerfasserIn] |
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| Links: |
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| Themen: |
Adrenal Cortex Hormones |
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| Anmerkungen: |
Date Completed 02.10.2023 Date Revised 05.10.2023 published: Print Citation Status MEDLINE |
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| doi: |
10.1136/bmjresp-2023-001814 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| 245 | 1 | 0 | |a Inhalation devices and inhaled corticosteroids particle size influence on severe pneumonia in patients with chronic obstructive pulmonary disease |b a nationwide cohort study |
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| 520 | |a © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. | ||
| 520 | |a BACKGROUND: Inhaled 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 | ||
| 520 | |a METHODS: An 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 | ||
| 520 | |a RESULTS: A 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) | ||
| 520 | |a INTERPRETATION: The 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 | ||
| 650 | 4 | |a Observational Study | |
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a COPD epidemiology | |
| 650 | 4 | |a Inhaler devices | |
| 650 | 4 | |a Pneumonia | |
| 650 | 4 | |a Respiratory Infection | |
| 650 | 7 | |a Adrenal Cortex Hormones |2 NLM | |
| 700 | 1 | |a Rønn, Christian |e verfasserin |4 aut | |
| 700 | 1 | |a Harboe, Zitta Barrella |e verfasserin |4 aut | |
| 700 | 1 | |a Ingebrigtsen, Truls Sylvan |e verfasserin |4 aut | |
| 700 | 1 | |a Svorre Jordan, Alexander |e verfasserin |4 aut | |
| 700 | 1 | |a Wilcke, Jon Torgny |e verfasserin |4 aut | |
| 700 | 1 | |a Bonnesen, Barbara |e verfasserin |4 aut | |
| 700 | 1 | |a Biering-Sørensen, Tor |e verfasserin |4 aut | |
| 700 | 1 | |a Sørensen, Rikke |e verfasserin |4 aut | |
| 700 | 1 | |a Holler, Jon Gitz |e verfasserin |4 aut | |
| 700 | 1 | |a Itenov, Theis Skovsgaard |e verfasserin |4 aut | |
| 700 | 1 | |a Johansen, Helle Krogh |e verfasserin |4 aut | |
| 700 | 1 | |a Sivapalan, Pradeesh |e verfasserin |4 aut | |
| 700 | 1 | |a Eklöf, Josefin |e verfasserin |4 aut | |
| 700 | 1 | |a Jensen, Jens-Ulrik Stæhr |e verfasserin |4 aut | |
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