Inhaled corticosteroids and Stenotrophomonas maltophilia in outpatients with chronic obstructive pulmonary disease: a retrospective cohort study

Christian Rønn*, Peter Kamstrup, Christian Kjer Heerfordt, Pradeesh Sivapalan, Josefin Eklöf, Jonas Bredtoft Boel, Christian Ostergaard, Ram Benny Dessau, Mia Moberg, Julie Janner, Charlotte Suppli Ulrik, Jens Ulrik Stæhr Jensen

*Corresponding author for this work

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Abstract

Objectives Inhaled corticosteroids (ICS) are widely used in patients with chronic obstructive pulmonary disease (COPD). However, ICS are associated with an increased risk of adverse effects. We aimed to determine whether an association between a lower respiratory tract culture with Stenotrophomonas maltophilia and increasing ICS dosing in patients with COPD exists. Design An observational cohort study of outpatients with COPD in Denmark between 2010 and 2018. ICS exposure was categorised into four groups based on average daily consumption 1 year prior to inclusion: no use, low ICS dose (≤400 µg), moderate ICS dose (400-800 µg) and high ICS dose (>800 µg). Dose-response relationship was investigated by a multivariable Cox proportional hazards regression. Results Of the total 22 689 patients, 459 had lower respiratory tract cultures positive for S. maltophilia. The HR of S. maltophilia increased with increasing daily ICS dose: low ICS dose HR 2.6 (95% CI 1.6 to 4.0), moderate ICS dose HR 3.0 (95% CI 1.9 to 4.6) and high ICS dose HR 5.7 (95% CI 3.8 to 8.5). Conclusions We found that ICS was associated with a high, dose-dependent increased hazard of S. maltophilia in outpatients with COPD. High dose users had a nearly six times increased hazard compared with non-users of ICS. When appropriate, attempts at de-escalating ICS treatment should be made.

Original languageEnglish
Article numbere001929
JournalBMJ Open Respiratory Research
Volume11
Issue number1
Number of pages7
ISSN2052-4439
DOIs
Publication statusPublished - 9. Mar 2024

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