Use of inhaled corticosteroids and risk of acquiring Pseudomonas aeruginosa in patients with chronic obstructive pulmonary disease

Josefin Eklöf, Truls Sylvan Ingebrigtsen, Rikke Sørensen, Mohamad Isam Saeed, Imane Achir Alispahic, Pradeesh Sivapalan, Jonas Bredtoft Boel, Jette Bangsborg, Christian Ostergaard, Ram Benny Dessau, Ulrich Stab Jensen, Ejvind Frausing Hansen, Therese Sophie Lapperre, Howraman Meteran, Torgny Wilcke, Niels Seersholm, Jens-Ulrik Stæhr Jensen

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

BACKGROUND: Inhaled corticosteroids (ICS) are commonly used to treat COPD and are associated with increased risk of pneumonia. The aim of this study was to assess if accumulated use of ICS is associated with a dose-dependent risk of a positive airway culture with Pseudomonas aeruginosa in patients with COPD.

METHODS: We conducted a multiregional epidemiological cohort study including Danish COPD patients followed in outpatient clinics during 2010-2017. ICS use was categorised based on accumulated prescriptions redeemed 365 days prior to cohort entry. Cox proportional hazard regression model was used to estimate the risk of acquiring P. aeruginosa. Propensity score matched models were used as sensitivity analyses.

RESULTS: A total of 21 408 patients were included in the study, of which 763 (3.6%) acquired P. aeruginosa during follow-up. ICS use was associated with a dose-dependent risk of P. aeruginosa (low ICS dose: HR 1.38, 95% CI 1.03 to 1.84, p=0.03; moderate ICS dose: HR 2.16, 95% CI 1.63 to 2.85, p<0.0001; high ICS dose: HR 3.58, 95% CI 2.75 to 4.65, p<0.0001; reference: no ICS use). A propensity matched model confirmed the results (high ICS dose compared with no/low/moderate ICS dose: HR 2.05, 95% CI 1.76 to 2.39, p p<0.0001).

CONCLUSION: Use of ICS in patients with COPD followed in Danish outpatient clinics was associated with a substantially increased and dose-dependent risk of acquiring P. aeruginosa. Caution should be taken when administering high doses of ICS in severely ill patients with COPD. These results should be confirmed in comparable cohorts and other settings.

Original languageEnglish
JournalThorax
ISSN0040-6376
DOIs
Publication statusE-pub ahead of print - 26. Aug 2021

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