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Pneumonia and pneumonia related mortality in patients with COPD treated with fixed combinations of inhaled corticosteroid and long acting β2 agonist: observational matched cohort study (PATHOS).
BMJ. 2013 May 29; 346:f3306.BMJ

Abstract

OBJECTIVE

To investigate the occurrence of pneumonia and pneumonia related events in patients with chronic obstructive pulmonary disease (COPD) treated with two different fixed combinations of inhaled corticosteroid/long acting β2 agonist.

DESIGN

Observational retrospective pairwise cohort study matched (1:1) for propensity score.

SETTING

Primary care medical records data linked to Swedish hospital, drug, and cause of death registry data for years 1999-2009.

PARTICIPANTS

Patients with COPD diagnosed by a physician and prescriptions of either budesonide/formoterol or fluticasone/salmeterol.

MAIN OUTCOME MEASURES

Yearly pneumonia event rates, admission to hospital related to pneumonia, and mortality.

RESULTS

9893 patients were eligible for matching (2738 in the fluticasone/salmeterol group; 7155 in the budesonide/formoterol group), yielding two matched cohorts of 2734 patients each. In these patients, 2115 (39%) had at least one recorded episode of pneumonia during the study period, with 2746 episodes recorded during 19,170 patient years of follow up. Compared with budesonide/formoterol, rate of pneumonia and admission to hospital were higher in patients treated with fluticasone/salmeterol: rate ratio 1.73 (95% confidence interval 1.57 to 1.90; P<0.001) and 1.74 (1.56 to 1.94; P<0.001), respectively. The pneumonia event rate per 100 patient years for fluticasone/salmeterol versus budesonide/formoterol was 11.0 (10.4 to 11.8) versus 6.4 (6.0 to 6.9) and the rate of admission to hospital was 7.4 (6.9 to 8.0) versus 4.3 (3.9 to 4.6). The mean duration of admissions related to pneumonia was similar for both groups, but mortality related to pneumonia was higher in the fluticasone/salmeterol group (97 deaths) than in the budesonide/formoterol group (52 deaths) (hazard ratio 1.76, 1.22 to 2.53; P=0.003). All cause mortality did not differ between the treatments (1.08, 0.93 to 1.14; P=0.59).

CONCLUSIONS

There is an intra-class difference between fixed combinations of inhaled corticosteroid/long acting β2 agonist with regard to the risk of pneumonia and pneumonia related events in the treatment of patients with COPD.

TRIAL REGISTRATION

Clinical Trials.gov NCT01146392.

Authors+Show Affiliations

Department of Medical Sciences, Respiratory Medicine, Uppsala University, Uppsala, Sweden. christer.janson@medsci.uu.seNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

23719639

Citation

Janson, Christer, et al. "Pneumonia and Pneumonia Related Mortality in Patients With COPD Treated With Fixed Combinations of Inhaled Corticosteroid and Long Acting Β2 Agonist: Observational Matched Cohort Study (PATHOS)." BMJ (Clinical Research Ed.), vol. 346, 2013, pp. f3306.
Janson C, Larsson K, Lisspers KH, et al. Pneumonia and pneumonia related mortality in patients with COPD treated with fixed combinations of inhaled corticosteroid and long acting β2 agonist: observational matched cohort study (PATHOS). BMJ. 2013;346:f3306.
Janson, C., Larsson, K., Lisspers, K. H., Ställberg, B., Stratelis, G., Goike, H., Jörgensen, L., & Johansson, G. (2013). Pneumonia and pneumonia related mortality in patients with COPD treated with fixed combinations of inhaled corticosteroid and long acting β2 agonist: observational matched cohort study (PATHOS). BMJ (Clinical Research Ed.), 346, f3306. https://doi.org/10.1136/bmj.f3306
Janson C, et al. Pneumonia and Pneumonia Related Mortality in Patients With COPD Treated With Fixed Combinations of Inhaled Corticosteroid and Long Acting Β2 Agonist: Observational Matched Cohort Study (PATHOS). BMJ. 2013 May 29;346:f3306. PubMed PMID: 23719639.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Pneumonia and pneumonia related mortality in patients with COPD treated with fixed combinations of inhaled corticosteroid and long acting β2 agonist: observational matched cohort study (PATHOS). AU - Janson,Christer, AU - Larsson,Kjell, AU - Lisspers,Karin H, AU - Ställberg,Björn, AU - Stratelis,Georgios, AU - Goike,Helena, AU - Jörgensen,Leif, AU - Johansson,Gunnar, Y1 - 2013/05/29/ PY - 2013/5/31/entrez PY - 2013/5/31/pubmed PY - 2013/7/23/medline SP - f3306 EP - f3306 JF - BMJ (Clinical research ed.) JO - BMJ VL - 346 N2 - OBJECTIVE: To investigate the occurrence of pneumonia and pneumonia related events in patients with chronic obstructive pulmonary disease (COPD) treated with two different fixed combinations of inhaled corticosteroid/long acting β2 agonist. DESIGN: Observational retrospective pairwise cohort study matched (1:1) for propensity score. SETTING: Primary care medical records data linked to Swedish hospital, drug, and cause of death registry data for years 1999-2009. PARTICIPANTS: Patients with COPD diagnosed by a physician and prescriptions of either budesonide/formoterol or fluticasone/salmeterol. MAIN OUTCOME MEASURES: Yearly pneumonia event rates, admission to hospital related to pneumonia, and mortality. RESULTS: 9893 patients were eligible for matching (2738 in the fluticasone/salmeterol group; 7155 in the budesonide/formoterol group), yielding two matched cohorts of 2734 patients each. In these patients, 2115 (39%) had at least one recorded episode of pneumonia during the study period, with 2746 episodes recorded during 19,170 patient years of follow up. Compared with budesonide/formoterol, rate of pneumonia and admission to hospital were higher in patients treated with fluticasone/salmeterol: rate ratio 1.73 (95% confidence interval 1.57 to 1.90; P<0.001) and 1.74 (1.56 to 1.94; P<0.001), respectively. The pneumonia event rate per 100 patient years for fluticasone/salmeterol versus budesonide/formoterol was 11.0 (10.4 to 11.8) versus 6.4 (6.0 to 6.9) and the rate of admission to hospital was 7.4 (6.9 to 8.0) versus 4.3 (3.9 to 4.6). The mean duration of admissions related to pneumonia was similar for both groups, but mortality related to pneumonia was higher in the fluticasone/salmeterol group (97 deaths) than in the budesonide/formoterol group (52 deaths) (hazard ratio 1.76, 1.22 to 2.53; P=0.003). All cause mortality did not differ between the treatments (1.08, 0.93 to 1.14; P=0.59). CONCLUSIONS: There is an intra-class difference between fixed combinations of inhaled corticosteroid/long acting β2 agonist with regard to the risk of pneumonia and pneumonia related events in the treatment of patients with COPD. TRIAL REGISTRATION: Clinical Trials.gov NCT01146392. SN - 1756-1833 UR - https://www.unboundmedicine.com/medline/citation/23719639/Pneumonia_and_pneumonia_related_mortality_in_patients_with_COPD_treated_with_fixed_combinations_of_inhaled_corticosteroid_and_long_acting_β2_agonist:_observational_matched_cohort_study__PATHOS__ L2 - http://www.bmj.com/lookup/pmidlookup?view=long&amp;pmid=23719639 DB - PRIME DP - Unbound Medicine ER -