Inhaled Corticosteroids in Patients with Chronic Obstructive Pulmonary Disease and Risk of Acquiring Streptococcus pneumoniae Infection. A Multiregional Epidemiological Study

• DOI: 10.2147/copd.s386518
• Publication Date: 2023-03-21T05:45:12Z
• Authors: Christian Kjer He...; Josefin Eklöf; Pradeesh Sivapalan; Truls Sylvan Inge...; Tor Biering-Sørensen; Zitta Barrella Ha...; Jesper Koefod Pet...; Christian Østerga...; Jonas Bredtoft Boel; Anne Kathrine Bock; Alexander G Mathi...; John R Hurst; Shailesh Kolekar; Sofie Lock Johansson; Jette Marie Bangs...; Jens Otto Jarløv; Ram Benny Dessau; Christian Borbjer...; Michael Perch; Jens-Ulrik Stæhr ...
• Keywords: Chronic Obstructive; Adrenal Cortex Hormones/adverse effects; clinical epidemiology.; International Journal of Chronic Obstructive Pulmonary Disease; Pneumococcal Infections; Pulmonary Disease; Diseases of the respiratory system; Pulmonary Disease, Chronic Obstructive; 03 medical and health sciences; 0302 clinical medicine; Adrenal Cortex Hormones; Chronic Obstructive/diagnosis; Administration, Inhalation; COPD; Humans; Pneumococcal Infections/diagnosis; Original Research; streptococcus pneumoniae; RC705-779; Pneumonia/chemically induced; copd; clinical epidemiology; Pneumonia; 3. Good health; Epidemiologic Studies; Streptococcus pneumoniae; Inhalation; Administration; inhaled corticosteroids; COPD-management

Inhaled corticosteroids (ICS) are associated with an increased risk of clinical pneumonia among patients with chronic obstructive pulmonary disease (COPD). It is unknown whether the risk of microbiologically verified pneumonia such as pneumococcal pneumonia is increased in ICS users.The study population consists of all COPD patients followed in outpatient clinics in eastern Denmark during 2010-2017. ICS use was categorized into four categories based on accumulated use. A Cox proportional hazard regression model was used adjusting for age, body mass index, sex, airflow limitation, use of oral corticosteroids, smoking, and year of cohort entry. A propensity score matched analysis was performed for sensitivity analyses.A total of 21,438 patients were included. Five hundred and eighty-two (2.6%) patients acquired a positive lower airway tract sample with S. pneumoniae during follow-up. In the multivariable analysis ICS-use was associated with a dose-dependent risk of S. pneumoniae as follows: low ICS dose: HR 1.11, 95% CI 0.84 to 1.45, p = 0.5; moderate ICS dose: HR 1.47, 95% CI 1.13 to 1.90, p = 0.004; high ICS dose: HR 1.77, 95% CI 1.38 to 2.29, p < 0.0001, compared to no ICS use. Sensitivity analyses confirmed these results.Use of ICS in patients with severe COPD was associated with an increased and dose-dependent risk of acquiring S. pneumoniae, but only for moderate and high dose. Caution should be taken when administering high dose of ICS to patients with COPD. Low dose of ICS seemed not to carry this risk.