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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TL;DR: In patients with COPD treated with formoterol, blood eosinophil count predicts exacerbation risk and the clinical response to ICS.
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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.
References
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TL;DR: It is demonstrated that fluticasone propionate is retained in lung tissue for a long time and serum concentrations after a single inhaled dose are low, which may promote high topical anti-inflammatory activity.
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Inhaled and nasal glucocorticoids and the risks of ocular hypertension or open-angle glaucoma.
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Effect of budesonide/formoterol pMDI on COPD exacerbations: A double-blind, randomized study
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Inhaled corticosteroids in COPD: the case against
S Suissa,Peter J. Barnes +1 more
TL;DR: The use of inhaled formulations of corticosteroids were shown to be highly effective for the treatment of asthma and were readily adopted in COPD with no scientific evidence of their benefit in this indication, but today, market research studies estimate that the use of these drugs has increased to the point that they are used by >70% of patients with COPD in the USA and Europe.
Journal ArticleDOI
Low-dose inhaled and nasal corticosteroid use and the risk of cataracts.
TL;DR: It is concluded that, among the elderly, even low doses of inhaled corticosteroids are associated with a small but significant excess risk of cataracts requiring extraction, and the increase in risk was apparent even at daily doses of ≤500 μg.