Samy Suissa1, Janie Coulombe2, Pierre Ernst3. 1. Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital; Department of Epidemiology and Biostatistics, McGill University, Montreal, QC, Canada. Electronic address: samy.suissa@mcgill.ca. 2. Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital. 3. Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital; Department of Epidemiology and Biostatistics, McGill University, Montreal, QC, Canada.
Abstract
BACKGROUND: The widespread use of inhaled corticosteroids (ICSs) for COPD treatment has been questioned. Recent studies of weaning some patients with COPD off ICSs found little or no adverse consequences compared with long-acting bronchodilators. It is unclear, however, whether discontinuation of ICSs reduces the elevated risk of pneumonia associated with these drugs. METHODS: Using the Quebec health insurance databases, we formed a new-user cohort of patients with COPD treated with ICSs during 1990 to 2005 and followed through 2007 or until a serious pneumonia event, defined as a first hospitalization for or death from pneumonia. A nested case-control analysis of the cohort was used to estimate the rate ratio of serious pneumonia associated with discontinuation of ICS use compared with continued use, adjusted for age, sex, respiratory disease severity, and comorbidity. RESULTS: The cohort included 103,386 users of ICSs, of whom 14,020 had a serious pneumonia event during 4.9 years of follow-up (incidence rate, 2.8/100/y). Discontinuation of ICSs was associated with a 37% decrease in the rate of serious pneumonia (rate ratio [RR], 0.63; 95% CI, 0.60-0.66). The risk reduction was rapidly evident, going from 20% in the first month to 50% by the fourth month after discontinuation. The risk reduction was particularly marked with fluticasone (RR, 0.58; 95% CI, 0.54-0.61) but less so with budesonide (RR, 0.87; 95% CI, 0.78-0.97). CONCLUSIONS: Discontinuation of ICS use in COPD is associated with a reduction in the elevated risk of serious pneumonia, particularly so with fluticasone.
BACKGROUND: The widespread use of inhaled corticosteroids (ICSs) for COPD treatment has been questioned. Recent studies of weaning some patients with COPD off ICSs found little or no adverse consequences compared with long-acting bronchodilators. It is unclear, however, whether discontinuation of ICSs reduces the elevated risk of pneumonia associated with these drugs. METHODS: Using the Quebec health insurance databases, we formed a new-user cohort of patients with COPD treated with ICSs during 1990 to 2005 and followed through 2007 or until a serious pneumonia event, defined as a first hospitalization for or death from pneumonia. A nested case-control analysis of the cohort was used to estimate the rate ratio of serious pneumonia associated with discontinuation of ICS use compared with continued use, adjusted for age, sex, respiratory disease severity, and comorbidity. RESULTS: The cohort included 103,386 users of ICSs, of whom 14,020 had a serious pneumonia event during 4.9 years of follow-up (incidence rate, 2.8/100/y). Discontinuation of ICSs was associated with a 37% decrease in the rate of serious pneumonia (rate ratio [RR], 0.63; 95% CI, 0.60-0.66). The risk reduction was rapidly evident, going from 20% in the first month to 50% by the fourth month after discontinuation. The risk reduction was particularly marked with fluticasone (RR, 0.58; 95% CI, 0.54-0.61) but less so with budesonide (RR, 0.87; 95% CI, 0.78-0.97). CONCLUSIONS: Discontinuation of ICS use in COPD is associated with a reduction in the elevated risk of serious pneumonia, particularly so with fluticasone.
Authors: Thomas Keller; Laura J Spece; Lucas M Donovan; Edmunds Udris; Scott S Coggeshall; Matthew Griffith; Alexander D Bryant; Richard Casaburi; J Allen Cooper; Gerard J Criner; Philip T Diaz; Anne L Fuhlbrigge; Steven E Gay; Richard E Kanner; Fernando J Martinez; Ralph J Panos; David Shade; Alice Sternberg; Thomas Stibolt; James K Stoller; James Tonascia; Robert Wise; Roger D Yusen; David H Au; Laura C Feemster Journal: Chest Date: 2020-04-09 Impact factor: 9.410
Authors: Krysttel Stryczek; Colby Lea; Chris Gillespie; George Sayre; Scott Wanner; Seppo T Rinne; Renda Soylemez Wiener; Laura Feemster; Edmunds Udris; David H Au; Christian D Helfrich Journal: J Gen Intern Med Date: 2019-08-08 Impact factor: 5.128
Authors: Matthew F Griffith; Laura C Feemster; Steven B Zeliadt; Lucas M Donovan; Laura J Spece; Edmunds M Udris; David H Au Journal: J Gen Intern Med Date: 2019-11-11 Impact factor: 5.128
Authors: Laura J Spece; Lucas M Donovan; Matthew F Griffith; Thomas Keller; Laura C Feemster; Nicholas L Smith; David H Au Journal: Ann Am Thorac Soc Date: 2020-05