Publication

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

Sonnappa, S., Martin, R. M., Israel, E., Postma, D., van Aalderen, W. M. C., Burden, A., Usmani, O. S., Price, D. B., Resp Effectiveness Grp & Small Airways Study Grp 15-Jun-2017 In : Plos one. 12, 6, 14 p., 0178112

Research output: Scientific - peer-reviewArticle

  • Samatha Sonnappa
  • Richard M. Martin
  • Elliot Israel
  • Dirkje Postma
  • Wim M C van Aalderen
  • Annie Burden
  • Omar S. Usmani
  • David B. Price
  • Resp Effectiveness Grp
  • Small Airways Study Grp

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.

Original languageEnglish
Article number0178112
Number of pages14
JournalPlos one
Volume12
Issue number6
StatePublished - 15-Jun-2017

    Keywords

  • HYDROFLUOROALKANE-134A BECLOMETHASONE DIPROPIONATE, RECEPTOR NUCLEAR TRANSLOCATION, PULMONARY-DISEASE, SALMETEROL/FLUTICASONE PROPIONATE, THERAPY GUIDELINES, APPROXIMATELY HALF, COPD PATIENTS, ASTHMA, EXACERBATIONS, SALMETEROL

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