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Inhaled corticosteroid use in patients with chronic obstructive pulmonary disease and the risk of pneumonia: a retrospective claims data analysis.

Abstract

BACKGROUND

The use of inhaled corticosteroids in patients with chronic obstructive pulmonary disease (COPD) has been associated with an increased risk of pneumonia in controlled clinical trials and case-control analyses.

OBJECTIVE

Using claims databases as a research model of real-world diagnosis and treatment, to determine if the use and dose of inhaled corticosteroids (ICS) among patients with newly diagnosed COPD are associated with increased risk of pneumonia.

PATIENTS AND METHODS

This was a retrospective cohort analysis of patients diagnosed with COPD between January 01, 2006 and September 30, 2010, drawn from databases (years 2006-2010). Patients (aged ≥45 years) were followed until first pneumonia diagnosis, end of benefit enrollment, or December 31, 2010, whichever was earliest. A Cox proportional hazard model was used to assess the association of ICS use and risk of pneumonia, controlling for baseline characteristics. Daily ICS use was classified into low, medium, and high doses (1 μg-499 μg, 500 μg-999 μg, and ≥1000 μg fluticasone equivalents daily) and was modeled as a time-dependent variable.

RESULTS

Among 135,445 qualifying patients with a total of 243,097 person-years, there were 1020 pneumonia incidences out of 5677 person-years on ICS (crude incidence rate, 0.180 per person-year), and 27,730 pneumonia incidences out of 237,420 person-years not on ICS (crude incidence rate, 0.117 per person-year). ICS use was associated with a dose-related increase in risk of pneumonia, with adjusted hazard ratios (versus no use; (95% confidence interval) of 1.38 (1.27-1.49) for low-dose users, 1.69 (1.52-1.88) for medium-dose users, and 2.57 (1.98-3.33) for high-dose users (P < 0.01 versus no use and between doses).

CONCLUSION

The use of ICS in newly diagnosed patients with COPD is potentially associated with a dose-related increase in the risk of pneumonia.

Authors+Show Affiliations

Department of Research, Olmsted Medical Center, Rochester, MN 55904, USA. byawn@olmmed.orgNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

23836970

Citation

Yawn, Barbara P., et al. "Inhaled Corticosteroid Use in Patients With Chronic Obstructive Pulmonary Disease and the Risk of Pneumonia: a Retrospective Claims Data Analysis." International Journal of Chronic Obstructive Pulmonary Disease, vol. 8, 2013, pp. 295-304.
Yawn BP, Li Y, Tian H, et al. Inhaled corticosteroid use in patients with chronic obstructive pulmonary disease and the risk of pneumonia: a retrospective claims data analysis. Int J Chron Obstruct Pulmon Dis. 2013;8:295-304.
Yawn, B. P., Li, Y., Tian, H., Zhang, J., Arcona, S., & Kahler, K. H. (2013). Inhaled corticosteroid use in patients with chronic obstructive pulmonary disease and the risk of pneumonia: a retrospective claims data analysis. International Journal of Chronic Obstructive Pulmonary Disease, 8, 295-304. https://doi.org/10.2147/COPD.S42366
Yawn BP, et al. Inhaled Corticosteroid Use in Patients With Chronic Obstructive Pulmonary Disease and the Risk of Pneumonia: a Retrospective Claims Data Analysis. Int J Chron Obstruct Pulmon Dis. 2013;8:295-304. PubMed PMID: 23836970.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Inhaled corticosteroid use in patients with chronic obstructive pulmonary disease and the risk of pneumonia: a retrospective claims data analysis. AU - Yawn,Barbara P, AU - Li,Yunfeng, AU - Tian,Haijun, AU - Zhang,Jie, AU - Arcona,Steve, AU - Kahler,Kristijan H, Y1 - 2013/06/27/ PY - 2013/7/10/entrez PY - 2013/7/10/pubmed PY - 2013/11/8/medline KW - COPD KW - ICS KW - LABA KW - pneumonia SP - 295 EP - 304 JF - International journal of chronic obstructive pulmonary disease JO - Int J Chron Obstruct Pulmon Dis VL - 8 N2 - BACKGROUND: The use of inhaled corticosteroids in patients with chronic obstructive pulmonary disease (COPD) has been associated with an increased risk of pneumonia in controlled clinical trials and case-control analyses. OBJECTIVE: Using claims databases as a research model of real-world diagnosis and treatment, to determine if the use and dose of inhaled corticosteroids (ICS) among patients with newly diagnosed COPD are associated with increased risk of pneumonia. PATIENTS AND METHODS: This was a retrospective cohort analysis of patients diagnosed with COPD between January 01, 2006 and September 30, 2010, drawn from databases (years 2006-2010). Patients (aged ≥45 years) were followed until first pneumonia diagnosis, end of benefit enrollment, or December 31, 2010, whichever was earliest. A Cox proportional hazard model was used to assess the association of ICS use and risk of pneumonia, controlling for baseline characteristics. Daily ICS use was classified into low, medium, and high doses (1 μg-499 μg, 500 μg-999 μg, and ≥1000 μg fluticasone equivalents daily) and was modeled as a time-dependent variable. RESULTS: Among 135,445 qualifying patients with a total of 243,097 person-years, there were 1020 pneumonia incidences out of 5677 person-years on ICS (crude incidence rate, 0.180 per person-year), and 27,730 pneumonia incidences out of 237,420 person-years not on ICS (crude incidence rate, 0.117 per person-year). ICS use was associated with a dose-related increase in risk of pneumonia, with adjusted hazard ratios (versus no use; (95% confidence interval) of 1.38 (1.27-1.49) for low-dose users, 1.69 (1.52-1.88) for medium-dose users, and 2.57 (1.98-3.33) for high-dose users (P < 0.01 versus no use and between doses). CONCLUSION: The use of ICS in newly diagnosed patients with COPD is potentially associated with a dose-related increase in the risk of pneumonia. SN - 1178-2005 UR - https://www.unboundmedicine.com/medline/citation/23836970/Inhaled_corticosteroid_use_in_patients_with_chronic_obstructive_pulmonary_disease_and_the_risk_of_pneumonia:_a_retrospective_claims_data_analysis_ L2 - https://dx.doi.org/10.2147/COPD.S42366 DB - PRIME DP - Unbound Medicine ER -