Inhaled Corticosteroids in Patients with Chronic Obstructive Pulmonary Disease and Risk of Acquiring Streptococcus Pneumoniae Infection. A Multiregional Epidemiological study

Background: Inhaled corticosteroids(ICS) are associated with an increased risk of clinical pneumonia among patients with COPD.Aims: Investigating whether the risk of microbiologically verified pneumococcal pneumonia is increased in ICS users in a dose-depend manner.Methods: The study population consists of all COPD patients followed in outpatient clinics in eastern Denmark. ICS use was categorized into four categories based on accumulated use. A Cox proportional hazard regression model was used adjusting for age, BMI, sex, airflow limitation, use of oral corticosteroids, smoking, and year of cohort entry.Results: A total of 21,438 patients were included. 582 (2.6%) patients acquired a positive lower airway tract sample with S. pneumoniae during follow-up. In the multivariable analysis ICS-use was associated with a dose-dependent risk of S. pneumoniae as follows low ICS dose: HR 1.11, 95% CI 0.84 to 1.45, p=0.5; moderate ICS dose: HR 1.47, 95% CI 1.13 to 1.90, p=0.004; high ICS dose: HR 1.77, 95% CI 1.38 to 2.29, p<0.0001.Conclusions: Use of ICS in patients with severe COPD was associated with an increased and dose-dependent risk of acquiring S. pneumoniae, but only for moderate and high dose. Caution should be taken when administering high dose of ICS to patients with COPD.Adjusted Cumulative incidence of positive S. pneumoniae samples.FootnotesCite this article as Eur Respir J 2022; 60: Suppl. 66, 1619.This article was presented at the 2022 ERS International Congress, in session “-”.This is an ERS International Congress abstract. No full-text version is available. Further material to accompany this abstract may be available at www.ers-education.org (ERS member access only).