학술논문
Use of inhaled corticosteroids and risk of acquiring Pseudomonas aeruginosain patients with chronic obstructive pulmonary disease
Document Type
Article
Author
Eklo¨f, Josefin; Ingebrigtsen, Truls Sylvan; Sørensen, Rikke; Saeed, Mohamad Isam; Alispahic, Imane Achir; Sivapalan, Pradeesh; Boel, Jonas Bredtoft; Bangsborg, Jette; Ostergaard, Christian; Dessau, Ram Benny; Jensen, Ulrich Stab; Hansen, Ejvind Frausing; Lapperre, Therese Sophie; Meteran, Howraman; Wilcke, Torgny; Seersholm, Niels; Jensen, Jens-Ulrik Stæhr
Source
Thorax; 2022, Vol. 77 Issue: 6 p573-580, 8p
Subject
Language
ISSN
00406376; 14683296
Abstract
BackgroundInhaled corticosteroids (ICS) are commonly used to treat COPD and are associated with increased risk of pneumonia. The aim of this study was to assess if accumulated use of ICS is associated with a dose-dependent risk of a positive airway culture with Pseudomonas aeruginosain patients with COPD.MethodsWe conducted a multiregional epidemiological cohort study including Danish COPD patients followed in outpatient clinics during 2010–2017. ICS use was categorised based on accumulated prescriptions redeemed 365 days prior to cohort entry. Cox proportional hazard regression model was used to estimate the risk of acquiring P. aeruginosa. Propensity score matched models were used as sensitivity analyses.ResultsA total of 21 408 patients were included in the study, of which 763 (3.6%) acquired P. aeruginosaduring follow-up. ICS use was associated with a dose-dependent risk of P. aeruginosa(low ICS dose: HR 1.38, 95% CI 1.03 to 1.84, p=0.03; moderate ICS dose: HR 2.16, 95% CI 1.63 to 2.85, p<0.0001; high ICS dose: HR 3.58, 95% CI 2.75 to 4.65, p<0.0001; reference: no ICS use). A propensity matched model confirmed the results (high ICS dose compared with no/low/moderate ICS dose: HR 2.05, 95% CI 1.76 to 2.39, p p<0.0001).ConclusionUse of ICS in patients with COPD followed in Danish outpatient clinics was associated with a substantially increased and dose-dependent risk of acquiring P. aeruginosa. Caution should be taken when administering high doses of ICS in severely ill patients with COPD. These results should be confirmed in comparable cohorts and other settings.