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Severe exacerbation and pneumonia in COPD patients treated with fixed combinations of inhaled corticosteroid and long-acting beta2 agonist.
Int J Chron Obstruct Pulmon Dis 2017; 12:2477-2485IJ

Abstract

BACKGROUND

It remains unclear whether severe exacerbation and pneumonia of COPD differs between patients treated with budesonide/formoterol and those treated with fluticasone/salmeterol. Therefore, we conducted a comparative study of those who used budesonide/formoterol and those treated with fluticasone/salmeterol for COPD.

METHODS

Subjects in this population-based cohort study comprised patients with COPD who were treated with a fixed combination of budesonide/formoterol or fluticasone/salmeterol. All patients were recruited from the Taiwan National Health Insurance database. The outcomes including severe exacerbations, pneumonia, and pneumonia requiring mechanical ventilation (MV) were measured.

RESULTS

During the study period, 11,519 COPD patients receiving fluticasone/salmeterol and 7,437 patients receiving budesonide/formoterol were enrolled in the study. Pairwise matching (1:1) of fluticasone/salmeterol and budesonide/formoterol populations resulted in to two similar subgroups comprising each 7,295 patients. Patients receiving fluticasone/salmeterol had higher annual rate and higher risk of severe exacerbation than patients receiving budesonide/formoterol (1.2219/year vs 1.1237/year, adjusted rate ratio, 1.08; 95% CI, 1.07-1.10). In addition, patients receiving fluticasone/salmeterol had higher incidence rate and higher risk of pneumonia than patients receiving budesonide/formoterol (12.11 per 100 person-years vs 10.65 per 100 person-years, adjusted hazard ratio [aHR], 1.13; 95% CI, 1.08-1.20). Finally, patients receiving fluticasone/salmeterol had higher incidence rate and higher risk of pneumonia requiring MV than patients receiving budesonide/formoterol (3.94 per 100 person-years vs 3.47 per 100 person-years, aHR, 1.14; 95% CI, 1.05-1.24). A similar trend was seen before and after propensity score matching analysis, intention-to-treat, and as-treated analysis with and without competing risk.

CONCLUSIONS

Based on this retrospective observational study, long-term treatment with fixed combination budesonide/formoterol was associated with fewer severe exacerbations, pneumonia, and pneumonia requiring MV than fluticasone/salmeterol in COPD patients.

Links

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    ncbi.nlm.nih.gov
    dx.doi.org

    Authors+Show Affiliations

    Yang HH
    Department of Intensive Care Medicine, Chi Mei Medical Center, Tainan. Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan.
    Lai CC
    Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying, Tainan.
    Wang YH
    Department of Internal Medicine, Cardinal Tien Hospital and School of Medicine, College of Medicine, Fu-Jen Catholic University, New Taipei City.
    Yang WC
    Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Miaoli County.
    Wang CY
    Department of Internal Medicine, Cardinal Tien Hospital and School of Medicine, College of Medicine, Fu-Jen Catholic University, New Taipei City.
    Wang HC
    Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan.
    Chen L
    Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Miaoli County.
    Yu CJ
    Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan.

    MeSH

    Administration, InhalationAdrenergic beta-2 Receptor AgonistsAgedBronchodilator AgentsBudesonide, Formoterol Fumarate Drug CombinationDatabases, FactualDisease ProgressionFemaleFluticasone-Salmeterol Drug CombinationGlucocorticoidsHumansLogistic ModelsLungMaleMiddle AgedPneumoniaPropensity ScoreProportional Hazards ModelsPulmonary Disease, Chronic ObstructiveRespiration, ArtificialRetrospective StudiesRisk FactorsSeverity of Illness IndexTaiwanTime FactorsTreatment Outcome

    Pub Type(s)

    Comparative Study
    Journal Article
    Observational Study

    Language

    eng

    PubMed ID

    28860742

    Citation

    Yang, Hsi-Hsing, et al. "Severe Exacerbation and Pneumonia in COPD Patients Treated With Fixed Combinations of Inhaled Corticosteroid and Long-acting Beta2 Agonist." International Journal of Chronic Obstructive Pulmonary Disease, vol. 12, 2017, pp. 2477-2485.
    Yang HH, Lai CC, Wang YH, et al. Severe exacerbation and pneumonia in COPD patients treated with fixed combinations of inhaled corticosteroid and long-acting beta2 agonist. Int J Chron Obstruct Pulmon Dis. 2017;12:2477-2485.
    Yang, H. H., Lai, C. C., Wang, Y. H., Yang, W. C., Wang, C. Y., Wang, H. C., ... Yu, C. J. (2017). Severe exacerbation and pneumonia in COPD patients treated with fixed combinations of inhaled corticosteroid and long-acting beta2 agonist. International Journal of Chronic Obstructive Pulmonary Disease, 12, pp. 2477-2485. doi:10.2147/COPD.S139035.
    Yang HH, et al. Severe Exacerbation and Pneumonia in COPD Patients Treated With Fixed Combinations of Inhaled Corticosteroid and Long-acting Beta2 Agonist. Int J Chron Obstruct Pulmon Dis. 2017;12:2477-2485. PubMed PMID: 28860742.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Severe exacerbation and pneumonia in COPD patients treated with fixed combinations of inhaled corticosteroid and long-acting beta2 agonist. AU - Yang,Hsi-Hsing, AU - Lai,Chih-Cheng, AU - Wang,Ya-Hui, AU - Yang,Wei-Chih, AU - Wang,Cheng-Yi, AU - Wang,Hao-Chien, AU - Chen,Likwang, AU - Yu,Chong-Jen, Y1 - 2017/08/21/ PY - 2017/9/2/entrez PY - 2017/9/2/pubmed PY - 2018/5/15/medline KW - COPD KW - ICS/LABA KW - exacerbation KW - pneumonia SP - 2477 EP - 2485 JF - International journal of chronic obstructive pulmonary disease JO - Int J Chron Obstruct Pulmon Dis VL - 12 N2 - BACKGROUND: It remains unclear whether severe exacerbation and pneumonia of COPD differs between patients treated with budesonide/formoterol and those treated with fluticasone/salmeterol. Therefore, we conducted a comparative study of those who used budesonide/formoterol and those treated with fluticasone/salmeterol for COPD. METHODS: Subjects in this population-based cohort study comprised patients with COPD who were treated with a fixed combination of budesonide/formoterol or fluticasone/salmeterol. All patients were recruited from the Taiwan National Health Insurance database. The outcomes including severe exacerbations, pneumonia, and pneumonia requiring mechanical ventilation (MV) were measured. RESULTS: During the study period, 11,519 COPD patients receiving fluticasone/salmeterol and 7,437 patients receiving budesonide/formoterol were enrolled in the study. Pairwise matching (1:1) of fluticasone/salmeterol and budesonide/formoterol populations resulted in to two similar subgroups comprising each 7,295 patients. Patients receiving fluticasone/salmeterol had higher annual rate and higher risk of severe exacerbation than patients receiving budesonide/formoterol (1.2219/year vs 1.1237/year, adjusted rate ratio, 1.08; 95% CI, 1.07-1.10). In addition, patients receiving fluticasone/salmeterol had higher incidence rate and higher risk of pneumonia than patients receiving budesonide/formoterol (12.11 per 100 person-years vs 10.65 per 100 person-years, adjusted hazard ratio [aHR], 1.13; 95% CI, 1.08-1.20). Finally, patients receiving fluticasone/salmeterol had higher incidence rate and higher risk of pneumonia requiring MV than patients receiving budesonide/formoterol (3.94 per 100 person-years vs 3.47 per 100 person-years, aHR, 1.14; 95% CI, 1.05-1.24). A similar trend was seen before and after propensity score matching analysis, intention-to-treat, and as-treated analysis with and without competing risk. CONCLUSIONS: Based on this retrospective observational study, long-term treatment with fixed combination budesonide/formoterol was associated with fewer severe exacerbations, pneumonia, and pneumonia requiring MV than fluticasone/salmeterol in COPD patients. SN - 1178-2005 UR - https://www.unboundmedicine.com/medline/citation/28860742/Severe_exacerbation_and_pneumonia_in_COPD_patients_treated_with_fixed_combinations_of_inhaled_corticosteroid_and_long_acting_beta2_agonist_ L2 - https://dx.doi.org/10.2147/COPD.S139035 DB - PRIME DP - Unbound Medicine ER -
    Grapherence [↓5 ↑22]

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