Hospitalization for chronic obstructive pulmonary disease and pneumonia: association with the dose of inhaled corticosteroids. A nation-wide cohort study of 52 100 outpatients
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Hospitalization for chronic obstructive pulmonary disease and pneumonia : association with the dose of inhaled corticosteroids. A nation-wide cohort study of 52 100 outpatients. / Rønn, Christian; Sivapalan, Pradeesh; Eklöf, Josefin; Kamstrup, Peter; Biering-Sørensen, Tor; Bonnesen, Barbara; Harboe, Zitta Barrella; Browatzki, Andrea; Kjærgaard, Jakob Lyngby; Meyer, Christian Niels; Jensen, Torben Tranborg; Johansson, Sofie Lock; Bendstrup, Elisabeth; Ulrik, Charlotte Suppli; Stæhr Jensen, Jens Ulrik.
In: Clinical Microbiology and Infection, Vol. 29, No. 4, 2023, p. 523-529.Research output: Contribution to journal › Journal article › Research › peer-review
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TY - JOUR
T1 - Hospitalization for chronic obstructive pulmonary disease and pneumonia
T2 - association with the dose of inhaled corticosteroids. A nation-wide cohort study of 52 100 outpatients
AU - Rønn, Christian
AU - Sivapalan, Pradeesh
AU - Eklöf, Josefin
AU - Kamstrup, Peter
AU - Biering-Sørensen, Tor
AU - Bonnesen, Barbara
AU - Harboe, Zitta Barrella
AU - Browatzki, Andrea
AU - Kjærgaard, Jakob Lyngby
AU - Meyer, Christian Niels
AU - Jensen, Torben Tranborg
AU - Johansson, Sofie Lock
AU - Bendstrup, Elisabeth
AU - Ulrik, Charlotte Suppli
AU - Stæhr Jensen, Jens Ulrik
N1 - Publisher Copyright: © 2022 The Author(s)
PY - 2023
Y1 - 2023
N2 - Objectives: International guidelines only advocate the use of inhaled corticosteroids (ICSs) in patients with chronic obstructive pulmonary disease (COPD) experiencing recurring exacerbations and eosinophilic inflammation. However, ICSs are commonly used in patients with COPD and without exacerbations and signs of eosinophilic inflammation, thus possibly increasing the risk of hospitalization for pneumonia. Thus, we aimed to determine the risk of hospitalization for pneumonia associated with increasing cumulated ICS doses among patients with COPD to establish whether there is dose dependency. Methods: A retrospective cohort study included all patients with COPD treated at a respiratory outpatient clinic in Denmark. The patients were divided into four groups based on their average daily ICS exposure. The dose-response relationship was investigated using a multivariable Cox proportional hazard regression analysis. Results: In total, 52 100 patients were included, who were divided into the no-use (n = 15 755), low-dose (n = 12 050), moderate-dose (n = 12 488), and high-dose (n = 11 807) groups. ICS use was strongly associated with hospitalization for pneumonia (hazard ratio [HR], 1.3; CI, 1.2–1.3) (ICS vs. no ICS). The risk of hospitalization for pneumonia increased with every dosing group step: low dose: HR, 1.1 (CI, 1.0–1.2); moderate dose: HR, 1.2 (CI, 1.1–1.3), and high dose: HR, 1.5 (CI, 1.4–1.6); “no use” was the reference. Sensitivity analyses confirmed these findings. Conclusions: In the dose-response relationship analysis, ICS dose were associated with a substantially increased risk of hospitalization for pneumonia of up to 50%. Our data support that ICSs should be administered at the lowest possible dose and only to patients with COPD who have a documented need.
AB - Objectives: International guidelines only advocate the use of inhaled corticosteroids (ICSs) in patients with chronic obstructive pulmonary disease (COPD) experiencing recurring exacerbations and eosinophilic inflammation. However, ICSs are commonly used in patients with COPD and without exacerbations and signs of eosinophilic inflammation, thus possibly increasing the risk of hospitalization for pneumonia. Thus, we aimed to determine the risk of hospitalization for pneumonia associated with increasing cumulated ICS doses among patients with COPD to establish whether there is dose dependency. Methods: A retrospective cohort study included all patients with COPD treated at a respiratory outpatient clinic in Denmark. The patients were divided into four groups based on their average daily ICS exposure. The dose-response relationship was investigated using a multivariable Cox proportional hazard regression analysis. Results: In total, 52 100 patients were included, who were divided into the no-use (n = 15 755), low-dose (n = 12 050), moderate-dose (n = 12 488), and high-dose (n = 11 807) groups. ICS use was strongly associated with hospitalization for pneumonia (hazard ratio [HR], 1.3; CI, 1.2–1.3) (ICS vs. no ICS). The risk of hospitalization for pneumonia increased with every dosing group step: low dose: HR, 1.1 (CI, 1.0–1.2); moderate dose: HR, 1.2 (CI, 1.1–1.3), and high dose: HR, 1.5 (CI, 1.4–1.6); “no use” was the reference. Sensitivity analyses confirmed these findings. Conclusions: In the dose-response relationship analysis, ICS dose were associated with a substantially increased risk of hospitalization for pneumonia of up to 50%. Our data support that ICSs should be administered at the lowest possible dose and only to patients with COPD who have a documented need.
KW - Corticosteroid
KW - Hospitalization
KW - Inhalation
KW - Pneumonia
U2 - 10.1016/j.cmi.2022.11.029
DO - 10.1016/j.cmi.2022.11.029
M3 - Journal article
C2 - 36503112
AN - SCOPUS:85145713940
VL - 29
SP - 523
EP - 529
JO - Clinical Microbiology and Infection
JF - Clinical Microbiology and Infection
SN - 1198-743X
IS - 4
ER -
ID: 334303694