Showing papers by "Pierre Ernst published in 2011"

Inhaled Corticosteroids and Risk of Tuberculosis in Patients with Respiratory Diseases

Abstract: Rationale: Treatment with substantial doses of oral corticosteroids (OCS) for prolonged periods increases the risk of tuberculosis (TB). However, little is known about the effect of inhaled corticosteroids (ICS) in this respect.Objectives: We quantified the independent contribution of ICS to the risk of TB in a population of patients with airway diseases.Methods: A population-based cohort design with a nested case-control analysis was used. A cohort of patients with airways disease was formed using the Quebec databases. TB cases were identified and age-matched control subjects were selected from all subjects who entered the cohort in the same month as the cases. TB incidence among the cohort was compared with the general population of Quebec using the standardized incidence ratio.Measurements and Main Results: The cohort consisted of 427,648 subjects. There were 564 cases of TB identified between 1990 and 2005. The standardized incidence ratio was 3.9 (95% confidence interval [CI], 2.6–5.4). Any and curre...

Risks of pneumonia in patients with asthma taking inhaled corticosteroids.

Abstract: Rationale: Inhaled corticosteroids (ICS) are the mainstay of asthma treatment. Studies in chronic obstructive pulmonary disease reported increased rates of pneumonia with ICS. Concerns exist about an increased pneumonia risk in patients with asthma taking ICS.Objectives: To evaluate the risks of pneumonia in patients with asthma taking ICS.Methods: A retrospective analysis evaluated studies of the ICS budesonide in asthma. The primary data set were all double-blind, placebo-controlled trials lasting at least 3 months, involving budesonide (26 trials, n = 9,067 for budesonide; n = 5,926 for the comparator) sponsored by AstraZeneca. A secondary data set evaluated all double-blind trials lasting at least 3 months but without placebo control (60 trials, n = 33,496 for budesonide, n = 2,773 for fluticasone propionate). Cox proportional hazards regression modeling was used to estimate the relative effect of ICS on pneumonia adverse events (AEs) or serious adverse events (SAEs).Measurements and Main Results: In ...

Gender differences in survival following hospitalisation for COPD

Abstract: Background Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. Gender differences in the clinical expression of COPD are increasingly recognised, but outcome differences have not been systematically examined. Gender differences in survival and rate of rehospitalisation were investigated in a large cohort of elderly patients with chronic airflow obstruction hospitalised for COPD. Methods The databases from the Quebec provincial health insurance plan were used. The study population included subjects aged >66 years who received ≥3 prescriptions for respiratory medications in any 1-year period between 1 January 1990 and 31 December 2001. The study cohort consisted of patients with a first hospitalisation for COPD, after selection into the study population. Patients were followed until death or 31 December 2003. The Kaplan–Meier method was used to estimate time to death and time to first hospitalisation for obstructive airways disease (COPD or asthma). The Cox proportional hazards model was used to determine the effect of male gender on all-cause mortality and rehospitalisation. Results The cohort consisted of 19 260 women and 23 893 men with a mean age of 77 years. 11 245 (58.4%) women and 16 754 (70.1%) men died after cohort entry. Male sex was associated with a significantly increased risk of death (adjusted HR 1.45, 95% CI 1.42 to 1.49) and with a significantly increased risk of rehospitalisation for obstructive airways disease (adjusted HR 1.12, 95% CI 1.09 to 1.15). Conclusion Mean survival and time to rehospitalisation for obstructive airways disease are significantly better for female patients.

Mega trials in COPD--clinical data analysis and design issues.

Abstract: Randomizowane, kontrolowane badania nad lekami TORCH i UPLIFT dostarczyly istotnych informacji o korzyściach z ich stosowania u chorych na POChP, a takze byly lekcją dotyczącą wplywu planowania badan i analizy wynikow na jakośc uzyskanych wynikow. Celem badania TORCH bylo porownanie stosowanego leczenia z leczeniem rutynowym, jednakze grupa placebo nie otrzymywala rutynowego leczenia. TORCH i UPLIFT byly jednymi z pierwszych badan, w ktorych analiza wynikow oparta byla na zasadzie " intention-to-treat ", bardzo waznej dla unikniecia wątpliwości w badaniach randomizowanych. Jednakze ta zasada obejmowala tylko analize umieralności, ale juz nie czynności pluc. Z tego powodu ta druga ulegala wplywowi zjawiska regresji do średniej. Natomiast dodatkowa analiza wynikow badania TORCH wykazala, ze korzystny wplyw na umieralnośc byl spowodowany wylącznie dlugodzialającym lekiem rozszerzającym oskrzela bez wplywu na obnizenie umieralności na POChP wziewnego steroidu w leczeniu skojarzonym. Łącznie, wyniki tych badan sugerują, ze obnizenie umieralności na POChP jest związane z dlugodzialającymi lekami rozszerzającymi oskrzela, w tym antycholinergikami, takimi jak tiotropium i agonistami receptorow beta, a nie z dzialaniem wziewnych kortykosteroidow. Przewlekla obturacyjna choroba pluc jest jedną z glownych przyczyn chorobowości i umieralności na świecie. Wielkie badania kliniczne, takie jak TORCH i UPLIFT, są potrzebne, ale powinny byc prowadzone z najwyzszą naukową starannością w planowaniu i analizie wynikow. Pneumonol. Alergol. Pol. 2011; 79, 3: 227-231