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Inhaled Corticosteroid use and the Risk of Pneumonia and COPD Exacerbations in the UPLIFT Study.
Lung. 2017 06; 195(3):281-288.LUNG

Abstract

RATIONALE

Unlike many other COPD studies, the 4-year UPLIFT trial permitted inhaled corticosteroid (ICS) use during run-in and treatment phases. This provided the opportunity to prospectively observe the continuing effects of ICS on respiratory events in closely observed COPD population.

OBJECTIVES

We aimed to determine rate and number of episodes of pneumonia and exacerbations of COPD in patients entering the study on no ICS, fluticasone proprionate (FP), and other ICS.

METHODS

The UPLIFT dataset was examined retrospectively, and patients were divided into three groups based on their medications at entry: no ICS, FP and other ICS. Poisson regression was used to compare the frequency of respiratory adverse events.

MEASUREMENTS AND MAIN RESULTS

At entry, the groups were well matched apart from a higher FEV1% predicted (38 vs. 41%; ICS vs. no ICS, respectively) and prevalence of current smoking (26 vs. 36%; ICS vs. no ICS, respectively). Incidence rates of pneumonia were significantly higher in patients taking ICS compared to no ICS (0.068 vs. 0.056 respectively; p = 0.012). When the FP group was compared to the other ICS, the event rate was even higher (0.077 vs. 0.058, respectively; p < 0.001). COPD exacerbations were more frequent in patients taking ICS, with significantly greater rate in the FP group compared to that seen with other ICS (0.93 vs. 0.84 respectively; p = 0.013).

CONCLUSIONS

ICS use was associated an increase in respiratory adverse event rates, but whether this was due to more severe illness at entry is unknown. In subgroup analysis, the excess of morbidity in the ICS group appeared to be mainly associated with those receiving FP at randomisation.

Authors+Show Affiliations

Centre for Cardiovascular & Metabolic Research, Hull York Medical School, University of Hull, Castle Hill Hospital, Castle Road, Cottingham, HU6 5JQ, UK. Department of Respiratory Medicine, Royal Brompton & Harefield NHS Trust, Harefield Hospital, Hill End road, Harefield, UB9 6JH, UK.Centre for Cardiovascular & Metabolic Research, Hull York Medical School, University of Hull, Castle Hill Hospital, Castle Road, Cottingham, HU6 5JQ, UK.Centre for Cardiovascular & Metabolic Research, Hull York Medical School, University of Hull, Castle Hill Hospital, Castle Road, Cottingham, HU6 5JQ, UK. a.h.morice@hull.ac.uk.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

28255905

Citation

Morjaria, Jaymin B., et al. "Inhaled Corticosteroid Use and the Risk of Pneumonia and COPD Exacerbations in the UPLIFT Study." Lung, vol. 195, no. 3, 2017, pp. 281-288.
Morjaria JB, Rigby A, Morice AH. Inhaled Corticosteroid use and the Risk of Pneumonia and COPD Exacerbations in the UPLIFT Study. Lung. 2017;195(3):281-288.
Morjaria, J. B., Rigby, A., & Morice, A. H. (2017). Inhaled Corticosteroid use and the Risk of Pneumonia and COPD Exacerbations in the UPLIFT Study. Lung, 195(3), 281-288. https://doi.org/10.1007/s00408-017-9990-8
Morjaria JB, Rigby A, Morice AH. Inhaled Corticosteroid Use and the Risk of Pneumonia and COPD Exacerbations in the UPLIFT Study. Lung. 2017;195(3):281-288. PubMed PMID: 28255905.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Inhaled Corticosteroid use and the Risk of Pneumonia and COPD Exacerbations in the UPLIFT Study. AU - Morjaria,Jaymin B, AU - Rigby,Alan, AU - Morice,Alyn H, Y1 - 2017/03/03/ PY - 2016/12/05/received PY - 2017/02/20/accepted PY - 2017/3/4/pubmed PY - 2018/3/20/medline PY - 2017/3/4/entrez KW - COPD KW - Fluticasone KW - Inhaled corticosteroids KW - Pneumonia KW - Tiotropium KW - UPLIFT SP - 281 EP - 288 JF - Lung JO - Lung VL - 195 IS - 3 N2 - RATIONALE: Unlike many other COPD studies, the 4-year UPLIFT trial permitted inhaled corticosteroid (ICS) use during run-in and treatment phases. This provided the opportunity to prospectively observe the continuing effects of ICS on respiratory events in closely observed COPD population. OBJECTIVES: We aimed to determine rate and number of episodes of pneumonia and exacerbations of COPD in patients entering the study on no ICS, fluticasone proprionate (FP), and other ICS. METHODS: The UPLIFT dataset was examined retrospectively, and patients were divided into three groups based on their medications at entry: no ICS, FP and other ICS. Poisson regression was used to compare the frequency of respiratory adverse events. MEASUREMENTS AND MAIN RESULTS: At entry, the groups were well matched apart from a higher FEV1% predicted (38 vs. 41%; ICS vs. no ICS, respectively) and prevalence of current smoking (26 vs. 36%; ICS vs. no ICS, respectively). Incidence rates of pneumonia were significantly higher in patients taking ICS compared to no ICS (0.068 vs. 0.056 respectively; p = 0.012). When the FP group was compared to the other ICS, the event rate was even higher (0.077 vs. 0.058, respectively; p < 0.001). COPD exacerbations were more frequent in patients taking ICS, with significantly greater rate in the FP group compared to that seen with other ICS (0.93 vs. 0.84 respectively; p = 0.013). CONCLUSIONS: ICS use was associated an increase in respiratory adverse event rates, but whether this was due to more severe illness at entry is unknown. In subgroup analysis, the excess of morbidity in the ICS group appeared to be mainly associated with those receiving FP at randomisation. SN - 1432-1750 UR - https://www.unboundmedicine.com/medline/citation/28255905/Inhaled_Corticosteroid_use_and_the_Risk_of_Pneumonia_and_COPD_Exacerbations_in_the_UPLIFT_Study_ L2 - https://dx.doi.org/10.1007/s00408-017-9990-8 DB - PRIME DP - Unbound Medicine ER -