Inhaled corticosteroids and risk of pneumonia in newly diagnosed COPD

Summary 

Introduction

The use of inhaled corticosteroids (ICS) in COPD may be associated with an increased risk of pneumonia. Little is known of this risk in newly diagnosed COPD patients. The objective of this study was to determine if the use of ICS among newly diagnosed COPD patients is associated with an increased risk of pneumonia hospitalizations.

Methods

Using data from the Department of Veterans Affairs and Centers for Medicare and Medicaid Services, a nested case–control study was performed. We identified patients 65 years of age or older with a new diagnosis of COPD from 1998 to 2002. A total of 145,586 patients were identified. Cases were defined based on hospitalization for pneumonia and exposure was prior use of ICS. Up to 10 controls were matched for each case based on age, sex, month and year of the case. The association between ICS use and pneumonia was evaluated with conditional logistic regression controlling for age, comorbidities, medication classes associated with the risk of pneumonia, and markers of COPD severity.

Results

There were 13,995 cases of pneumonia. The cohort was predominantly male with an average age of 75.1 (SD=5.4) years. The rate of pneumonia was 6.4 per 100 person-years. After adjustment for covariates, patients with current use of ICS were 1.38 (95% CI, 1.31–1.45) times more likely to have a hospitalization for pneumonia than those without current use of ICS.

Conclusions

The use of ICS among patients with newly diagnosed COPD is associated with an increased risk of hospitalization for pneumonia.

Keywords: Chronic obstructive pulmonary disease, Pneumonia, Corticosteroids, Drug therapy, Case–control studies