Ernst Pierre, Gonzalez Anne V, Brassard Paul, Suissa Samy
Pharmacoepidemiology Research Unit, Department of Medicine, McGill University Health Centre, and Division of Clinical Epidemiology, Ross 4.29, Royal Victoria Hospital, 687 Pine Avenue West, Montreal, PQ, Quebec, H3A 1A1 Canada.
Am J Respir Crit Care Med. 2007 Jul 15;176(2):162-6. doi: 10.1164/rccm.200611-1630OC. Epub 2007 Mar 30.
Inhaled corticosteroids are commonly prescribed to patients with chronic obstructive pulmonary disease (COPD).
To examine whether these medications might be associated with an excess risk of pneumonia.
We conducted a nested case-control study within a cohort of patients with COPD from Quebec, Canada, over the period 1988-2003, identified on the basis of administrative databases linking hospitalization and drug-dispensing information. Each subject hospitalized for pneumonia during follow-up (case subjects) was age and time matched to four control subjects. The effect of the use of inhaled corticosteroids was assessed by conditional logistic regression, after adjusting for comorbidity and COPD severity.
The cohort included 175,906 patients with COPD of whom 23,942 were hospitalized for pneumonia during follow-up, for a rate of 1.9 per 100 per year, and matched to 95,768 control subjects. The adjusted rate ratio of hospitalization for pneumonia associated with current use of inhaled corticosteroids was 1.70 (95% confidence interval [CI], 1.63-1.77) and 1.53 (95% CI, 1.30-1.80) for pneumonia hospitalization followed by death within 30 days. The rate ratio of hospitalization for pneumonia was greatest with the highest doses of inhaled corticosteroids, equivalent to fluticasone at 1,000 microg/day or more (rate ratio, 2.25; 95% CI, 2.07-2.44). All-cause mortality was similar for patients hospitalized for pneumonia, whether or not they had received inhaled corticosteroids in the recent past (7.4 and 8.2%, respectively).
The use of inhaled corticosteroids is associated with an excess risk of pneumonia hospitalization and of pneumonia hospitalization followed by death within 30 days, among elderly patients with COPD.
吸入性糖皮质激素常用于慢性阻塞性肺疾病（COPD）患者。
研究这些药物是否可能与肺炎风险增加有关。
我们在1988年至2003年期间对加拿大魁北克省的一组COPD患者进行了一项巢式病例对照研究，这些患者是根据连接住院和药物配给信息的行政数据库确定的。随访期间因肺炎住院的每个受试者（病例组）按年龄和时间与四个对照组受试者匹配。在调整合并症和COPD严重程度后，通过条件逻辑回归评估吸入性糖皮质激素使用的效果。
该队列包括175,906例COPD患者，其中23,942例在随访期间因肺炎住院，年发生率为每100人中有1.9例，并与95,768例对照受试者匹配。当前使用吸入性糖皮质激素与肺炎住院的校正率比为1.70（95%置信区间[CI]，1.63 - 1.77），对于肺炎住院后30天内死亡的情况，校正率比为1.53（95%CI，1.30 - 1.80）。吸入性糖皮质激素剂量最高时，肺炎住院率比最大，相当于氟替卡松每日1000微克或更高（率比，2.25；95%CI，2.07 - 2.44）。因肺炎住院的患者，无论近期是否接受过吸入性糖皮质激素治疗，全因死亡率相似（分别为7.4%和8.2%）。
在老年COPD患者中，使用吸入性糖皮质激素与肺炎住院风险增加以及肺炎住院后30天内死亡风险增加有关。
