Pneumonia Risk in Asthma Patients Using Inhaled Corticosteroids: a Quasi-cohort Study

Overview

Journal Br J Clin Pharmacol

Specialty Pharmacology

Date 2017 Apr 21

PMID 28425216

Citations 24

Authors

Christina J Qian

Janie Coulombe

Samy Suissa

Pierre Ernst

Affiliations

Soon will be listed here.

Abstract

Aim: Studies have linked the use of inhaled corticosteroids (ICSs) to excess pneumonia risk in chronic obstructive pulmonary disease patients. The risk in asthma patients remains unclear. The objective of the present study was to examine the risk of pneumonia with ICSs in asthma patients aged 12-35 years.

Methods: We formed a cohort of asthma patients treated from 1990 to 2007 using Quebec health insurance databases. Subjects were considered currently exposed if they had had an ICS dispensed within the 60 days prior to their pneumonia index event or matched person-moment. Secondary analyses investigated the risk of pneumonia according to ICS dose and type. Rate ratios (RRs) and rate differences (RDs) were both estimated through a quasi-cohort approach.

Results: The cohort included 152 412 subjects, of whom 1928 had a pneumonia event during follow-up. There was an increased risk of pneumonia associated with current use of ICSs [RR 1.83; 95% confidence interval (CI) 1.57, 2.14] or an excess risk of 1.44 cases per 1000 person-years (RD 1.44; 95% CI 1.03, 1.85). There was an excess pneumonia risk with low doses (RR 1.60; 95% CI 1.06, 2.45), moderate doses (RR 1.53; 95% CI 1.12, 2.08) and high doses (RR 1.96; 95% CI 1.64, 2.34) of ICSs, and with budesonide (RR 2.67; 95% CI 2.05, 3.49) and fluticasone (RR 1.93; 95% CI 1.58, 2.36), specifically relative to no use. When accounting for potential protopathic bias, the risk with current use of ICSs was attenuated (RR 1.48; 95% CI 1.22, 1.78).

Conclusion: ICS use in asthma patients appears to be associated with an increased risk of pneumonia and is present for both budesonide and fluticasone.

Citing Articles

Compatibility of hypokalaemia caused by low-dose prednisolone plus abiraterone acetate therapy for metastatic castration-resistant prostate cancer.

Torii S, Torii-Goto A, Tanizawa T, Sakakibara T, Oguri R, Nagase H J Pharm Health Care Sci. 2024; 10(1):72.

PMID: 39529147 PMC: 11552156. DOI: 10.1186/s40780-024-00391-5.

Unremitting Asthma as a Presentation of Pulmonary Nocardiosis: A Case Report.

Khan S, Ignatowicz A, Balaji N, Chew C, Mihilli A, Patel U Cureus. 2024; 16(2):e54722.

PMID: 38524073 PMC: 10960736. DOI: 10.7759/cureus.54722.

Use of inhaled corticosteroids and the risk of hospitalisation for pneumonia in children with asthma: a nationwide cohort study.

Sielinou Kamgang K, Arthur Rhedin S, Almqvist C, Wintzell V Thorax. 2024; 79(5):395-402.

PMID: 38184370 PMC: 11041608. DOI: 10.1136/thorax-2023-220742.

Neutrophil to lymphocyte ratio in pediatric patients with asthmatic exacerbation and community-acquired pneumonia.

Xu M, Zhou L, Zhang J, Luo S, Zhao Y, Xiong W BMC Pediatr. 2023; 23(1):640.

PMID: 38110898 PMC: 10726602. DOI: 10.1186/s12887-023-04456-6.

Asthma and COPD: A Focus on β-Agonists - Past, Present and Future.

Baker J, Shaw D Handb Exp Pharmacol. 2023; 285:369-451.

PMID: 37709918 DOI: 10.1007/164_2023_679.

References

Garbe E, LeLorier J, Boivin J, Suissa S . Inhaled and nasal glucocorticoids and the risks of ocular hypertension or open-angle glaucoma. JAMA. 1997; 277(9):722-7. View

Ernst P, Gonzalez A, Brassard P, Suissa S . Inhaled corticosteroid use in chronic obstructive pulmonary disease and the risk of hospitalization for pneumonia. Am J Respir Crit Care Med. 2007; 176(2):162-6. DOI: 10.1164/rccm.200611-1630OC. View

Suissa S, Kezouh A, Ernst P . Inhaled corticosteroids and the risks of diabetes onset and progression. Am J Med. 2010; 123(11):1001-6. DOI: 10.1016/j.amjmed.2010.06.019. View

Chapman K . The impact of budesonide and other inhaled corticosteroid therapies in the management of asthma in children and adults. Clin Ther. 2003; 25 Suppl C:C2-C14. DOI: 10.1016/s0149-2918(03)80302-8. View

OByrne P, Pedersen S, Carlsson L, Radner F, Thoren A, Peterson S . Risks of pneumonia in patients with asthma taking inhaled corticosteroids. Am J Respir Crit Care Med. 2010; 183(5):589-95. DOI: 10.1164/rccm.201005-0694OC. View

Horwitz R, Feinstein A . The problem of "protopathic bias" in case-control studies. Am J Med. 1980; 68(2):255-8. DOI: 10.1016/0002-9343(80)90363-0. View

Brassard P, Vutcovici M, Ernst P, Patenaude V, Sewitch M, Suissa S . Increased incidence of inflammatory bowel disease in Québec residents with airway diseases. Eur Respir J. 2014; 45(4):962-8. DOI: 10.1183/09031936.00079414. View

Lacasse Y, Montori V, Lanthier C, Maltis F . The validity of diagnosing chronic obstructive pulmonary disease from a large administrative database. Can Respir J. 2005; 12(5):251-6. DOI: 10.1155/2005/567975. View

Pandya D, Puttanna A, Balagopal V . Systemic effects of inhaled corticosteroids: an overview. Open Respir Med J. 2015; 8:59-65. PMC: 4319197. DOI: 10.2174/1874306401408010059. View

10.

Boulet L, Becker A, Berube D, Beveridge R, Ernst P . Canadian Asthma Consensus Report, 1999. Canadian Asthma Consensus Group. CMAJ. 2000; 161(11 Suppl):S1-61. PMC: 1230847. View

11.

Suissa S, Baltzan M, Kremer R, Ernst P . Inhaled and nasal corticosteroid use and the risk of fracture. Am J Respir Crit Care Med. 2003; 169(1):83-8. DOI: 10.1164/rccm.200305-640OC. View

12.

Lipworth B . Systemic adverse effects of inhaled corticosteroid therapy: A systematic review and meta-analysis. Arch Intern Med. 1999; 159(9):941-55. DOI: 10.1001/archinte.159.9.941. View

13.

Monso E, Ruiz J, Rosell A, Manterola J, Fiz J, Morera J . Bacterial infection in chronic obstructive pulmonary disease. A study of stable and exacerbated outpatients using the protected specimen brush. Am J Respir Crit Care Med. 1995; 152(4 Pt 1):1316-20. DOI: 10.1164/ajrccm.152.4.7551388. View

14.

Cadieux G, Tamblyn R . Accuracy of physician billing claims for identifying acute respiratory infections in primary care. Health Serv Res. 2008; 43(6):2223-38. PMC: 2614002. DOI: 10.1111/j.1475-6773.2008.00873.x. View

15.

Kern D, Davis J, Williams S, Tunceli O, Wu B, Hollis S . Validation of an administrative claims-based diagnostic code for pneumonia in a US-based commercially insured COPD population. Int J Chron Obstruct Pulmon Dis. 2015; 10:1417-25. PMC: 4516198. DOI: 10.2147/COPD.S83135. View

16.

Talbot T, Hartert T, Mitchel E, Halasa N, Arbogast P, Poehling K . Asthma as a risk factor for invasive pneumococcal disease. N Engl J Med. 2005; 352(20):2082-90. DOI: 10.1056/NEJMoa044113. View

17.

Marin A, Monso E, Garcia-Nunez M, Sauleda J, Noguera A, Pons J . Variability and effects of bronchial colonisation in patients with moderate COPD. Eur Respir J. 2009; 35(2):295-302. DOI: 10.1183/09031936.00126808. View

18.

Bansal V, Mangi M, Johnson M, Festic E . Inhaled corticosteroids and incident pneumonia in patients with asthma: Systematic review and meta-analysis. Acta Med Acad. 2015; 44(2):135-58. DOI: 10.5644/ama2006-124.141. View

19.

Blais L, Lemiere C, Menzies D, Berbiche D . Validity of asthma diagnoses recorded in the Medical Services database of Quebec. Pharmacoepidemiol Drug Saf. 2005; 15(4):245-52. DOI: 10.1002/pds.1202. View

20.

Blais L, Beauchesne M, Levesque S . Socioeconomic status and medication prescription patterns in pediatric asthma in Canada. J Adolesc Health. 2006; 38(5):607.e9-16. DOI: 10.1016/j.jadohealth.2005.02.010. View