Inhaled corticosteroids in COPD and the risk of serious pneumonia
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TLDR
ICS use by patients with COPD increases the risk of serious pneumonia, and the risk is particularly elevated and dose related with fluticasone, while residual confounding cannot be ruled out.Abstract:
Background Inhaled corticosteroids (ICS) are known to increase the risk of pneumonia in patients with chronic obstructive pulmonary disease (COPD). It is unclear whether the risk of pneumonia varies for different inhaled agents, particularly fluticasone and budesonide, and increases with the dose and long-term duration of use. Methods We formed a new-user cohort of patients with COPD treated during 1990–2005. Subjects were identified using the Quebec health insurance databases and followed through 2007 or until a serious pneumonia event, defined as a first hospitalisation for or death from pneumonia. A nested case–control analysis was used to estimate the rate ratio (RR) of serious pneumonia associated with current ICS use, adjusted for age, sex, respiratory disease severity and comorbidity. Results The cohort included 163 514 patients, of which 20 344 had a serious pneumonia event during the 5.4 years of follow-up (incidence rate 2.4/100/year). Current use of ICS was associated with a 69% increase in the rate of serious pneumonia (RR 1.69; 95% CI 1.63 to 1.75). The risk was sustained with long-term use and declined gradually after stopping ICS use, disappearing after 6 months (RR 1.08; 95% CI 0.99 to 1.17). The rate of serious pneumonia was higher with fluticasone (RR 2.01; 95% CI 1.93 to 2.10), increasing with the daily dose, but was much lower with budesonide (RR 1.17; 95% CI 1.09 to 1.26). Conclusions ICS use by patients with COPD increases the risk of serious pneumonia. The risk is particularly elevated and dose related with fluticasone. While residual confounding cannot be ruled out, the results are consistent with those from recent randomised trials.read more
Citations
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Benralizumab for chronic obstructive pulmonary disease and sputum eosinophilia: a randomised, double-blind, placebo-controlled, phase 2a study.
Christopher E. Brightling,Eugene R. Bleecker,Reynold A. Panettieri,Mona Bafadhel,Dewei She,Christine K. Ward,Xiao Xu,Claire Birrell,René van der Merwe +8 more
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Risk of COVID-19-related death among patients with chronic obstructive pulmonary disease or asthma prescribed inhaled corticosteroids: an observational cohort study using the OpenSAFELY platform.
Anna Schultze,Alex J Walker,Brian MacKenna,Caroline E Morton,Krishnan Bhaskaran,Jeremy P Brown,Christopher T Rentsch,Elizabeth Williamson,Henry Drysdale,Richard Croker,Seb Bacon,William J Hulme,Christopher M. Bates,Helen J Curtis,Amir Mehrkar,David M. Evans,Peter Inglesby,Jonathan Cockburn,Helen Mcdonald,Laurie A. Tomlinson,Rohini Mathur,Kevin Wing,Angel Y S Wong,Harriet Forbes,John Parry,Frank Hester,Sam Harper,Stephen J. W. Evans,Jennifer K Quint,Liam Smeeth,Ian J. Douglas,Ben Goldacre +31 more
TL;DR: The results do not support a major role for regular ICS use in protecting against COVID-19-related death among people with asthma or COPD, and the apparent harmful association observed can be plausibly explained by unmeasured confounding due to disease severity.
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Budesonide and the risk of pneumonia: a meta-analysis of individual patient data
Don D. Sin,Donald P. Tashkin,Xuekui Zhang,Finn Radner,Ulf Sjöbring,Anders Thorén,Peter M.A. Calverley,Stephen I. Rennard +7 more
TL;DR: Budesonide treatment for 12 months does not increase the risk of pneumonia in patients with COPD during that time and therefore is safe for clinical use in such patients.
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Association of Inhaled Corticosteroid Use With Cataract Extraction in Elderly Patients
TL;DR: Prolonged administration of high doses of inhaled corticosteroids increases the likelihood of undergoing cataract extraction in elderly patients, and the risk of developing cataracts for low to medium doses over longer periods is increased.