Inhalation devices and inhaled corticosteroids particle size influence on severe pneumonia in patients with chronic obstructive pulmonary disease: a nationwide cohort study
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Inhalation devices and inhaled corticosteroids particle size influence on severe pneumonia in patients with chronic obstructive pulmonary disease : a nationwide cohort study. / Heerfordt, Christian Kjer; Rønn, Christian; Harboe, Zitta Barrella; Ingebrigtsen, Truls Sylvan; Svorre Jordan, Alexander; Wilcke, Jon Torgny; Bonnesen, Barbara; Biering-Sørensen, Tor; Sørensen, Rikke; Holler, Jon Gitz; Itenov, Theis Skovsgaard; Johansen, Helle Krogh; Sivapalan, Pradeesh; Eklöf, Josefin; Jensen, Jens Ulrik Stæhr.
In: BMJ Open Respiratory Research, Vol. 10, No. 1, e001814. , 2023.Research output: Contribution to journal › Journal article › Research › peer-review
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TY - JOUR
T1 - Inhalation devices and inhaled corticosteroids particle size influence on severe pneumonia in patients with chronic obstructive pulmonary disease
T2 - a nationwide cohort study
AU - Heerfordt, Christian Kjer
AU - Rønn, Christian
AU - Harboe, Zitta Barrella
AU - Ingebrigtsen, Truls Sylvan
AU - Svorre Jordan, Alexander
AU - Wilcke, Jon Torgny
AU - Bonnesen, Barbara
AU - Biering-Sørensen, Tor
AU - Sørensen, Rikke
AU - Holler, Jon Gitz
AU - Itenov, Theis Skovsgaard
AU - Johansen, Helle Krogh
AU - Sivapalan, Pradeesh
AU - Eklöf, Josefin
AU - Jensen, Jens Ulrik Stæhr
N1 - Publisher Copyright: © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
PY - 2023
Y1 - 2023
N2 - BACKGROUND: Inhaled corticosteroids (ICSs) are associated with an increased risk of pneumonia among patients with chronic obstructive pulmonary disease (COPD). The introduction of extrafine particle ICS has aimed to improve the distribution of medicine in the airways by altering deposition within the lungs, potentially affecting efficacy and side effects. It remains unclear if extrafine particle ICS administration alters the risk of pneumonia compared with standard particle size ICS. METHODS: An observational cohort study including all Danish COPD outpatients receiving ICS from 2010 to 2017. The primary outcome was pneumonia hospitalisation in the different ICS particle dosing regimens. The primary analysis was an adjusted Cox proportional hazards model. For sensitivity analysis, a subgroup analysis of patients receiving spray devices was done. Further, we created a propensity score matched cohort, in which we matched for the same covariates as adjusted for in the main analysis. RESULTS: A total of 35 691 patients were included of whom 1471 received extrafine particle ICS. Among these patients, 4657 were hospitalised due to pneumonia. Patients with COPD receiving extrafine particle ICS had a lower risk of hospitalisation due to pneumonia compared with patients receiving standard particle size ICS in our primary analysis (HR 0.75; 95% CI 0.63 to 0.89; p=0.002), subgroup analysis (HR 0.54; 95% CI 0.45 to 0.65; p<0.0001) and the propensity-matched population (HR 0.72; 95% CI 0.60 to 0.87; p=0.0006). INTERPRETATION: The use of extrafine particle ICS administration was associated with a lower risk of pneumonia hospitalisation in patients with COPD compared with those who received standard size treatment.
AB - BACKGROUND: Inhaled corticosteroids (ICSs) are associated with an increased risk of pneumonia among patients with chronic obstructive pulmonary disease (COPD). The introduction of extrafine particle ICS has aimed to improve the distribution of medicine in the airways by altering deposition within the lungs, potentially affecting efficacy and side effects. It remains unclear if extrafine particle ICS administration alters the risk of pneumonia compared with standard particle size ICS. METHODS: An observational cohort study including all Danish COPD outpatients receiving ICS from 2010 to 2017. The primary outcome was pneumonia hospitalisation in the different ICS particle dosing regimens. The primary analysis was an adjusted Cox proportional hazards model. For sensitivity analysis, a subgroup analysis of patients receiving spray devices was done. Further, we created a propensity score matched cohort, in which we matched for the same covariates as adjusted for in the main analysis. RESULTS: A total of 35 691 patients were included of whom 1471 received extrafine particle ICS. Among these patients, 4657 were hospitalised due to pneumonia. Patients with COPD receiving extrafine particle ICS had a lower risk of hospitalisation due to pneumonia compared with patients receiving standard particle size ICS in our primary analysis (HR 0.75; 95% CI 0.63 to 0.89; p=0.002), subgroup analysis (HR 0.54; 95% CI 0.45 to 0.65; p<0.0001) and the propensity-matched population (HR 0.72; 95% CI 0.60 to 0.87; p=0.0006). INTERPRETATION: The use of extrafine particle ICS administration was associated with a lower risk of pneumonia hospitalisation in patients with COPD compared with those who received standard size treatment.
KW - COPD epidemiology
KW - Inhaler devices
KW - Pneumonia
KW - Respiratory Infection
UR - http://www.scopus.com/inward/record.url?scp=85172824667&partnerID=8YFLogxK
U2 - 10.1136/bmjresp-2023-001814
DO - 10.1136/bmjresp-2023-001814
M3 - Journal article
C2 - 37775111
AN - SCOPUS:85172824667
VL - 10
JO - B M J Open Respiratory Research
JF - B M J Open Respiratory Research
SN - 2052-4439
IS - 1
M1 - e001814.
ER -
ID: 369869634