Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
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Inhaled Corticosteroids May Not Affect the Clinical Outcomes of Pneumonia in Patients with Chronic Obstructive Pulmonary Disease

  • Min-Seok Chang (Department of Internal Medicine, Yonsei University Wonju College of Medicine) ;
  • In-So Cho (Department of Internal Medicine, Yonsei University Wonju College of Medicine) ;
  • Iseul Yu (Department of Internal Medicine, Yonsei University Wonju College of Medicine) ;
  • Sunmin Park (Department of Internal Medicine, Yonsei University Wonju College of Medicine) ;
  • Seok Jeong Lee (Department of Internal Medicine, Yonsei University Wonju College of Medicine) ;
  • Suk Joong Yong (Department of Internal Medicine, Yonsei University Wonju College of Medicine) ;
  • Won-Yeon Lee (Department of Internal Medicine, Yonsei University Wonju College of Medicine) ;
  • Sang-Ha Kim (Department of Internal Medicine, Yonsei University Wonju College of Medicine) ;
  • Ji-Ho Lee (Department of Internal Medicine, Yonsei University Wonju College of Medicine)
  • Received : 2023.10.28
  • Accepted : 2024.02.17
  • Published : 2024.07.31
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Abstract

Background: Although inhaled corticosteroids (ICS) is reportedly associated with a higher risk of pneumonia in chronic obstructive pulmonary disease (COPD), the clinical implications of ICS have not been sufficiently verified to determine their effect on the prognosis of pneumonia. Methods: The electronic health records of patients hospitalized for pneumonia with underlying COPD were retrospectively reviewed. Pneumonia was confirmed using chest radiography or computed tomography. The clinical outcomes of pneumonia in patients with COPD who received ICS and those who received long-acting bronchodilators other than ICS were compared. Results: Among the 255 hospitalized patients, 89 met the inclusion criteria. The numbers of ICS and non-ICS users were 46 and 43, respectively. The CURB-65 (confusion, uremia, respiratory rate, blood pressure, age ≥65 years) scores at the initial presentation of pneumonia were comparable between the two groups. The proportions of patients with multilobar infiltration, pleural effusion, and complicated pneumonia in the radiological studies did not vary between the two groups. Additionally, the defervescence time, proportion of mechanical ventilation, intensive care unit admission, length of hospital stays, and mortality rate at 30 and 90 days were not significantly different between the two groups. ICS use and blood eosinophils count were not associated with all pneumonia outcomes and mortality in multivariate analyses. Conclusion: The clinical outcomes of pneumonia following ICS use in patients with COPD did not differ from those in patients treated without ICS. Thus, ICS may not contribute to the severity and outcomes of pneumonia in patients with COPD.

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References

  1. Torres A, Blasi F, Dartois N, Akova M. Which individuals are at increased risk of pneumococcal disease and why?: impact of COPD, asthma, smoking, diabetes, and/or chronic heart disease on community-acquired pneumonia and invasive pneumococcal disease. Thorax 2015;70:984-9. https://doi.org/10.1136/thoraxjnl-2015-206780
  2. Ramirez JA, Wiemken TL, Peyrani P, Arnold FW, Kelley R, Mattingly WA, et al. Adults hospitalized with pneumonia in the united states: incidence, epidemiology, and mortality. Clin Infect Dis 2017;65:1806-12. https://doi.org/10.1093/cid/cix647
  3. Gautam SS, O'Toole RF. Convergence in the epidemiology and pathogenesis of COPD and pneumonia. COPD 2016;13:790-8. https://doi.org/10.1080/15412555.2016.1191456
  4. Hogg JC. Pathophysiology of airflow limitation in chronic obstructive pulmonary disease. Lancet 2004;364:709-21. https://doi.org/10.1016/S0140-6736(04)16900-6
  5. David B, Bafadhel M, Koenderman L, De Soyza A. Eosinophilic inflammation in COPD: from an inflammatory marker to a treatable trait. Thorax 2021;76:188-95. https://doi.org/10.1136/thoraxjnl-2020-215167
  6. Miravitlles M, Auladell-Rispau A, Monteagudo M, Vazquez-Niebla JC, Mohammed J, Nunez A, et al. Systematic review on long-term adverse effects of inhaled corticosteroids in the treatment of COPD. Eur Respir Rev 2021;30:210075.
  7. Finney L, Berry M, Singanayagam A, Elkin SL, Johnston SL, Mallia P. Inhaled corticosteroids and pneumonia in chronic obstructive pulmonary disease. Lancet Respir Med 2014;2:919-32. https://doi.org/10.1016/S2213-2600(14)70169-9
  8. Restrepo MI, Sibila O, Anzueto A. Pneumonia in patients with chronic obstructive pulmonary disease. Tuberc Respir Dis (Seoul) 2018;81:187-97. https://doi.org/10.4046/trd.2018.0030
  9. Ilg A, Moskowitz A, Konanki V, Patel PV, Chase M, Grossestreuer AV, et al. Performance of the CURB-65 score in predicting critical care interventions in patients admitted with community-acquired pneumonia. Ann Emerg Med 2019;74:60-8. https://doi.org/10.1016/j.annemergmed.2018.06.017
  10. Calverley PM, Anderson JA, Celli B, Ferguson GT, Jenkins C, Jones PW, et al. Salmeterol and fluticasone propionate and survival in chronic obstructive pulmonary disease. N Engl J Med 2007;356:775-89. https://doi.org/10.1056/NEJMoa063070
  11. Kardos P, Wencker M, Glaab T, Vogelmeier C. Impact of salmeterol/fluticasone propionate versus salmeterol on exacerbations in severe chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2007;175:144-9. https://doi.org/10.1164/rccm.200602-244OC
  12. Wedzicha JA, Calverley PM, Seemungal TA, Hagan G, Ansari Z, Stockley RA, et al. The prevention of chronic obstructive pulmonary disease exacerbations by salmeterol/fluticasone propionate or tiotropium bromide. Am J Respir Crit Care Med 2008;177:19-26. https://doi.org/10.1164/rccm.200707-973OC
  13. Dransfield MT, Bourbeau J, Jones PW, Hanania NA, Mahler DA, Vestbo J, et al. Once-daily inhaled fluticasone furoate and vilanterol versus vilanterol only for prevention of exacerbations of COPD: two replicate double-blind, parallel-group, randomised controlled trials. Lancet Respir Med 2013;1:210-23. https://doi.org/10.1016/S2213-2600(13)70040-7
  14. Mullerova H, Chigbo C, Hagan GW, Woodhead MA, Miravitlles M, Davis KJ, et al. The natural history of community-acquired pneumonia in COPD patients: a population database analysis. Respir Med 2012;106:1124-33. https://doi.org/10.1016/j.rmed.2012.04.008
  15. Suissa S, Patenaude V, Lapi F, Ernst P. Inhaled corticosteroids in COPD and the risk of serious pneumonia. Thorax 2013;68:1029-36. https://doi.org/10.1136/thoraxjnl-2012-202872
  16. Crim C, Dransfield MT, Bourbeau J, Jones PW, Hanania NA, Mahler DA, et al. Pneumonia risk with inhaled fluticasone furoate and vilanterol compared with vilanterol alone in patients with COPD. Ann Am Thorac Soc 2015;12:27-34. https://doi.org/10.1513/AnnalsATS.201409-413OC
  17. Celli BR, Fabbri LM, Aaron SD, Agusti A, Brook RD, Criner GJ, et al. Differential diagnosis of suspected chronic obstructive pulmonary disease exacerbations in the acute care setting: best practice. Am J Respir Crit Care Med 2023;207:1134-44. https://doi.org/10.1164/rccm.202209-1795CI
  18. Lieberman D, Lieberman D, Gelfer Y, Varshavsky R, Dvoskin B, Leinonen M, et al. Pneumonic vs nonpneumonic acute exacerbations of COPD. Chest 2002;122:1264-70. https://doi.org/10.1378/chest.122.4.1264
  19. Crim C, Calverley PM, Anderson JA, Celli B, Ferguson GT, Jenkins C, et al. Pneumonia risk in COPD patients receiving inhaled corticosteroids alone or in combination: TORCH study results. Eur Respir J 2009;34:641-7. https://doi.org/10.1183/09031936.00193908
  20. Agusti A, Fabbri LM, Singh D, Vestbo J, Celli B, Franssen FM, et al. Inhaled corticosteroids in COPD: friend or foe? Eur Respir J 2018;52:1801219.
  21. Chen D, Restrepo MI, Fine MJ, Pugh MJ, Anzueto A, Metersky ML, et al. Observational study of inhaled corticosteroids on outcomes for COPD patients with pneumonia. Am J Respir Crit Care Med 2011;184:312-6. https://doi.org/10.1164/rccm.201012-2070OC
  22. Malo de Molina R, Mortensen EM, Restrepo MI, Copeland LA, Pugh MJ, Anzueto A. Inhaled corticosteroid use is associated with lower mortality for subjects with COPD and hospitalised with pneumonia. Eur Respir J 2010;36:751-7. https://doi.org/10.1183/09031936.00077509
  23. Ernst P, Gonzalez AV, Brassard P, Suissa S. Inhaled corticosteroid use in chronic obstructive pulmonary disease and the risk of hospitalization for pneumonia. Am J Respir Crit Care Med 2007;176:162-6. https://doi.org/10.1164/rccm.200611-1630OC
  24. Singanayagam A, Chalmers JD, Akram AR, Hill AT. Impact of inhaled corticosteroid use on outcome in COPD patients admitted with pneumonia. Eur Respir J 2011;38:36-41. https://doi.org/10.1183/09031936.00077010
  25. Llewellyn-Jones CG, Harris TA, Stockley RA. Effect of fluticasone propionate on sputum of patients with chronic bronchitis and emphysema. Am J Respir Crit Care Med 1996;153:616-21. https://doi.org/10.1164/ajrccm.153.2.8564107
  26. van Overveld FJ, Demkow UA, Gorecka D, Zielinski J, De Backer WA. Inhibitory capacity of different steroids on neutrophil migration across a bilayer of endothelial and bronchial epithelial cells. Eur J Pharmacol 2003;477:261-7. https://doi.org/10.1016/S0014-2999(03)02153-8