help button home button
AJRCCM
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH
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
This Article
Right arrow Full Text (PDF)
Right arrow All Versions of this Article:
200611-1630OCv1
176/2/162    most recent
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Ernst, P.
Right arrow Articles by Suissa, S.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Ernst, P.
Right arrow Articles by Suissa, S.

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




This article has been cited by other articles:


Home page
 ANN INTERN MEDHome page
T. A. Lee, A. S. Pickard, D. H. Au, B. Bartle, and K. B. Weiss
Risk for Death Associated with Medications for Recently Diagnosed Chronic Obstructive Pulmonary Disease
Ann Intern Med, September 16, 2008; 149(6): 380 - 390.
[Abstract] [Full Text] [PDF]

Home page
 Am. J. Respir. Crit. Care Med.Home page
S. Suissa
Medications to Modify Lung Function Decline in Chronic Obstructive Pulmonary Disease: Some Hopeful Signs
Am. J. Respir. Crit. Care Med., August 15, 2008; 178(4): 322 - 323.
[Full Text] [PDF]

Home page
 ChestHome page
T. Benfield, P. Lange, and J. Vestbo
COPD Stage and Risk of Hospitalization for Infectious Disease
Chest, July 1, 2008; 134(1): 46 - 53.
[Abstract] [Full Text] [PDF]

Home page
 Eur Respir JHome page
P. Albert and P. M. A. Calverley
Drugs (including oxygen) in severe COPD
Eur. Respir. J., May 1, 2008; 31(5): 1114 - 1124.
[Abstract] [Full Text] [PDF]

Home page
 Am. J. Respir. Crit. Care Med.Home page
W. MacNee
Update in Chronic Obstructive Pulmonary Disease 2007
Am. J. Respir. Crit. Care Med., April 15, 2008; 177(8): 820 - 829.
[Full Text] [PDF]

Home page
 Am. J. Respir. Crit. Care Med.Home page
P. Ernst and S. Suissa
Inhaled Corticosteroids and Pneumonia in COPD: An Association Looking for Evidence
Am. J. Respir. Crit. Care Med., March 1, 2008; 177(5): 556 - 556.
[Full Text] [PDF]

Home page
 Am. J. Respir. Crit. Care Med.Home page
M. O. Turner
Inhaled Corticosteroids and Pneumonia in COPD: An Association Looking for Evidence
Am. J. Respir. Crit. Care Med., March 1, 2008; 177(5): 555 - 556.
[Full Text] [PDF]

Home page
 Am. J. Respir. Crit. Care Med.Home page
V. Brusasco, E. Crimi, and R. Pellegrino
Airway Inflammation in COPD: Friend or Foe?
Am. J. Respir. Crit. Care Med., September 1, 2007; 176(5): 425 - 426.
[Full Text] [PDF]

Home page
 JWatch Infect. DiseasesHome page
Do Inhaled Corticosteroids Increase Pneumonia Risk in COPD?
Journal Watch Infectious Diseases, July 18, 2007; 2007(718): 4 - 4.
[Full Text]

Home page
 Am. J. Respir. Crit. Care Med.Home page
M. Woodhead
Inhaled Corticosteroids Cause Pneumonia ...or Do They?
Am. J. Respir. Crit. Care Med., July 15, 2007; 176(2): 111 - 112.
[Full Text] [PDF]


HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH
Proc. Am. Thorac. Soc. Am. J. Respir. Cell Mol. Biol.
Copyright © 2007 American Thoracic Society