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PLoS One. 2017 Jun 15;12(6):e0178112. doi: 10.1371/journal.pone.0178112. eCollection 2017.

Risk of pneumonia in obstructive lung disease: A real-life study comparing extra-fine and fine-particle inhaled corticosteroids.

Author information

1
Observational and Pragmatic Research Institute Pte Ltd, Singapore, Singapore.
2
Department of Respiratory Paediatrics, Rainbow Children's Hospital, Bengaluru, India.
3
National Jewish Health and the University of Colorado Denver, Denver, Colorado, United States of America.
4
Pulmonary and Critical Care Division, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, United States of America.
5
Department of Pulmonary Medicine and Tuberculosis, University of Groningen, University Medical Center Groningen, the Netherlands.
6
Department of Pediatric Respiratory Diseases, Emma Children's Hospital AMC, Amsterdam, the Netherlands.
7
National Heart and Lung Institute, Imperial College London & Royal Brompton Hospital, London, United Kingdom.
8
Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom.

Abstract

BACKGROUND:

Regular use of inhaled corticosteroids (ICS) in patients with obstructive lung diseases has been associated with a higher risk of pneumonia, particularly in COPD. The risk of pneumonia has not been previously evaluated in relation to ICS particle size and dose used.

METHODS:

Historical cohort, UK database study of 23,013 patients with obstructive lung disease aged 12-80 years prescribed extra-fine or fine-particle ICS. The endpoints assessed during the outcome year were diagnosis of pneumonia, acute exacerbations and acute respiratory events in relation to ICS dose. To determine the association between ICS particle size, dose and risk of pneumonia in unmatched and matched treatment groups, logistic and conditional logistic regression models were used.

RESULTS:

14788 patients were stepped-up to fine-particle ICS and 8225 to extra-fine ICS. On unmatched analysis, patients stepping-up to extra-fine ICS were significantly less likely to be coded for pneumonia (adjusted odds ratio [aOR] 0.60; 95% CI 0.37, 0.97]); experience acute exacerbations (adjusted risk ratio [aRR] 0.91; 95%CI 0.85, 0.97); and acute respiratory events (aRR 0.90; 95%CI 0.86, 0.94) compared with patients stepping-up to fine-particle ICS. Patients prescribed daily ICS doses in excess of 700 mcg (fluticasone propionate equivalent) had a significantly higher risk of pneumonia (OR [95%CI] 2.38 [1.17, 4.83]) compared with patients prescribed lower doses, irrespective of particle size.

CONCLUSIONS:

These findings suggest that patients with obstructive lung disease on extra-fine particle ICS have a lower risk of pneumonia than those on fine-particle ICS, with those receiving higher ICS doses being at a greater risk.

PMID:
28617814
PMCID:
PMC5472262
DOI:
10.1371/journal.pone.0178112
[Indexed for MEDLINE]
Free PMC Article

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