Department of Public Health Sciences, School of Public Health.
Clin Infect Dis. 2013 Oct;57(8):1138-44. doi: 10.1093/cid/cit472. Epub 2013 Jul 19.
Studies have suggested an increased risk of pneumonia with inhaled corticosteroid (ICS) use, although this association is inconsistent. We evaluated the risk of recurrent pneumonia associated with ICS use in a high-risk population of individuals who survived an episode of pneumonia.
Clinical and 5-year follow-up data were collected on all adults aged ≥ 65 years with pneumonia over a period of 2 years. Using a nested case-control design, first cases (patients with recurrent pneumonia ≥ 30 days after initial episode) and then controls (free of pneumonia and matched on age, sex, and chronic obstructive pulmonary disease [COPD]) were identified. ICS use was classified as never, past (remote, only before initial pneumonia), or current. Our primary outcome measure was recurrent pneumonia assessed using conditional multivariate logistic regression after adjustment of demographics and clinical data.
During 5 years of follow-up, 653 recurrent pneumonia cases were matched with 6244 controls; mean age was 79 (SD, 8) years, 3577 (52%) were male, 2652 (38%) had COPD, and 2294 (33%) ever used ICS. Overall, 123 of 870 (14%) current ICS users had recurrent pneumonia compared to 395 of 4603 (9%) never-users (adjusted odds ratio, 1.90; 95% confidence interval, 1.45-2.50; P < .001; number need to harm = 20). Conversely, there was no association between past (remote) use of ICS and pneumonia: 9% of past users versus 9% never-users (P = .36).
ICS use was associated with a 90% relative increase in the risk of recurrent pneumonia among high-risk pneumonia survivors. This should be considered when prescribing ICS and when deciding which patients might need more intensive follow-up.
尽管吸入性皮质类固醇（ICS）的使用与肺炎风险增加有关，但这种关联并不一致。我们评估了在经历过肺炎发作的高危人群中，ICS 治疗与肺炎再发相关的风险。
在为期 2 年的时间内，我们收集了所有年龄≥65 岁、有肺炎病史的成年人的临床和 5 年随访数据。使用巢式病例对照设计，首先确定病例（初始发作后≥30 天发生肺炎再发的患者），然后确定对照（无肺炎且年龄、性别和慢性阻塞性肺疾病[COPD]匹配）。ICS 使用情况分为从未使用、过去（既往，仅在初始肺炎之前使用过）或当前使用。我们的主要观察指标是通过条件多变量逻辑回归，在调整人口统计学和临床数据后评估肺炎再发。
在 5 年的随访期间，共匹配到 653 例肺炎再发患者和 6244 例对照患者；平均年龄为 79（标准差，8）岁，3577 例（52%）为男性，2652 例（38%）患有 COPD，2294 例（33%）曾使用 ICS。总体而言，123 例（14%）当前 ICS 使用者发生了肺炎再发，而 4603 例（9%）从未使用者发生了肺炎再发（调整后的比值比，1.90；95%置信区间，1.45-2.50；P<0.001；需要伤害的人数=20）。相反，ICS 的既往（既往）使用与肺炎之间没有关联：9%的既往使用者与 9%的从未使用者（P=0.36）。
在经历过肺炎发作的高危人群中，ICS 使用与肺炎再发的风险增加 90%相关。在开具 ICS 处方和决定哪些患者可能需要更强化的随访时，应考虑这一点。
