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Risk of pneumonia in obstructive lung disease: A real-life study comparing extra-fine and fine-particle inhaled corticosteroids

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Title: Risk of pneumonia in obstructive lung disease: A real-life study comparing extra-fine and fine-particle inhaled corticosteroids
Authors: Sonnappa, S
Martin, R
Israel, E
Postma, D
Van Aalderen, W
Burden, A
Usmani, OS
Price, DB
Item Type: Journal Article
Abstract: Background: Regular use of inhaled corticosteroids (ICS) in patients with obstructive lung diseases has been associated with a higher risk of pneumonia, particularly in COPD. The risk of pneumonia has not been previously evaluated in relation to ICS particle size and dose used. Methods: Historical cohort, UK database study of 23,013 patients with obstructive lung disease aged 12–80 years prescribed extra-fine or fine-particle ICS. The endpoints assessed during the outcome year were diagnosis of pneumonia, acute exacerbations and acute respiratory events in relation to ICS dose. To determine the association between ICS particle size, dose and risk of pneumonia in unmatched and matched treatment groups, logistic and conditional logistic regression models were used. Results: 14788 patients were stepped-up to fine-particle ICS and 8225 to extra-fine ICS. On unmatched analysis, patients stepping-up to extra-fine ICS were significantly less likely to be coded for pneumonia (adjusted odds ratio [aOR] 0.60; 95% CI 0.37, 0.97]); experience acute exacerbations (adjusted risk ratio [aRR] 0.91; 95%CI 0.85, 0.97); and acute respiratory events (aRR 0.90; 95%CI 0.86, 0.94) compared with patients stepping-up to fine-particle ICS. Patients prescribed daily ICS doses in excess of 700 mcg (fluticasone propionate equivalent) had a significantly higher risk of pneumonia (OR [95%CI] 2.38 [1.17, 4.83]) compared with patients prescribed lower doses, irrespective of particle size. Conclusions: These findings suggest that patients with obstructive lung disease on extra-fine particle ICS have a lower risk of pneumonia than those on fine-particle ICS, with those receiving higher ICS doses being at a greater risk.
Issue Date: 15-Jun-2017
Date of Acceptance: 7-May-2017
URI: http://hdl.handle.net/10044/1/49953
DOI: https://dx.doi.org/10.1371/journal.pone.0178112
ISSN: 1932-6203
Publisher: PUBLIC LIBRARY OF SCIENCE
Journal / Book Title: PLOS ONE
Volume: 12
Issue: 6
Copyright Statement: © 2017 Sonnap pa et al. This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricte d use, distribu tion, and reproduction in any medium, provided the original author and source are credited.
Keywords: Science & Technology
Multidisciplinary Sciences
Science & Technology - Other Topics
HYDROFLUOROALKANE-134A BECLOMETHASONE DIPROPIONATE
RECEPTOR NUCLEAR TRANSLOCATION
PULMONARY-DISEASE
SALMETEROL/FLUTICASONE PROPIONATE
THERAPY GUIDELINES
APPROXIMATELY HALF
COPD PATIENTS
ASTHMA
EXACERBATIONS
SALMETEROL
Respiratory Effectiveness Group, Small Airways Study Group
MD Multidisciplinary
General Science & Technology
Publication Status: Published
Article Number: ARTN e0178112
Appears in Collections:National Heart and Lung Institute
Airway Disease
Faculty of Medicine



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