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Published ahead of print on March 30, 2007, doi:10.1164/rccm.200611-1630OC

Am. J. Respir. Crit. Care Med., Volume 176, Number 2, July 2007, 162-166

A more recent version of this article appeared on July 15, 2007
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Submitted on November 13, 2006
Accepted on March 29, 2007

Inhaled Corticosteroid Use in COPD and the Risk of Hospitalization for Pneumonia

Pierre Ernst1*, Anne V Gonzalez1, Paul Brassard1, and Samy Suissa1

1 Department of Medicine, McGill University Health Centre, Pharmacoepidemiology Research Unit, Montreal, Quebec, Canada

* To whom correspondence should be addressed. E-mail: pierre.ernst{at}mcgill.ca.

Background. Inhaled corticosteroids are commonly prescribed to patients with chronic obstructive pulmonary disease (COPD). Recent trials suggest that these medications might be associated with an excess risk of pneumonia. Methods. We conducted a nested case-control study within a cohort of COPD patients from Quebec, Canada, over the period 1988-2003, identified using administrative databases linking hospitalization and drug dispensing information. Each subject hospitalized for pneumonia during follow-up (cases) was age- and time-matched to four controls. The effect of the use of inhaled corticosteroids was assessed using conditional logistic regression, after adjusting for co-morbidity and COPD severity. Results. The cohort included 175,906 COPD patients of which 23,942 were hospitalized for pneumonia during follow-up, for a rate of 1.9 per 100 per year, and matched to 95,768 controls. The adjusted rate ratio (RR) of hospitalization for pneumonia associated with current use of inhaled corticosteroids was 1.70 (95% confidence interval (CI): 1.63-1.77) and 1.53 (95% CI: 1.30-1.80) for pneumonia hospitalization leading to death within 30 days. The rate ratio of hospitalization for pneumonia was greatest with the highest doses of inhaled corticosteroids, equivalent to fluticasone 1000mcg per day or more, (RR 2.25; 95% CI: 2.07-2.44). All cause mortality was similar for patients hospitalized for pneumonia, whether or not they had received inhaled corticosteroids in the recent past (7.4% and 8.2% respectively). Conclusion. The use of inhaled corticosteroids is associated with an excess risk of pneumonia hospitalization and of pneumonia hospitalization leading to death within 30 days, among elderly patients with COPD.
Key words: Chronic Obstructive Pulmonary Disease; Drug Therapy; Corticosteroids; Inhaled therapy; cohort studies




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