Yamauchi Yasuhiro, Yasunaga Hideo, Hasegawa Wakae, Sakamoto Yukiyo, Takeshima Hideyuki, Jo Taisuke, Matsui Hiroki, Fushimi Kiyohide, Nagase Takahide
Department of Respiratory Medicine, Graduate School of Medicine.
Department of Clinical Epidemiology and Health Economics, School of Public Health.
Int J Chron Obstruct Pulmon Dis. 2016 Jun 23;11:1403-11. doi: 10.2147/COPD.S107985. eCollection 2016.
Inhaled corticosteroids (ICS) and long-acting inhaled bronchodilators (IBD) are beneficial for the management of COPD. Although ICS has been reported to increase the risk of pneumonia in patients with COPD, it remains controversial whether it influences mortality. Using a Japanese national database, we examined the association between preadmission ICS therapy and in-hospital mortality from pneumonia in patients with COPD.
We retrospectively collected data from 1,165 hospitals in Japan on patients with COPD who received outpatient inhalation therapy and were admitted with pneumonia. Patients were categorized into those who received ICS with IBD and those who received IBD alone. We performed multivariate logistic regression analysis to examine the association between outpatient ICS therapy and in-hospital mortality, adjusting for the patients' backgrounds.
Of the 7,033 eligible patients, the IBD alone group (n=3,331) was more likely to be older, have lower body mass index, poorer general conditions, and more severe pneumonia than the ICS with IBD group (n=3,702). In-hospital mortality was 13.2% and 8.1% in the IBD alone and the ICS with IBD groups, respectively. After adjustment for patients' backgrounds, the ICS with IBD group had significantly lower mortality than the IBD alone group (adjusted odds ratio, 0.80; 95% confidence interval, 0.68-0.94). Higher mortality was associated with older age, being male, lower body mass index, poorer general status, and more severe pneumonia.
Outpatient inhaled ICS and IBD therapy was significantly associated with lower mortality from pneumonia in patients with COPD than treatment with IBD alone.
吸入性糖皮质激素（ICS）和长效吸入性支气管扩张剂（IBD）对慢性阻塞性肺疾病（COPD）的管理有益。尽管有报道称ICS会增加COPD患者肺炎的风险，但它是否影响死亡率仍存在争议。我们利用日本全国性数据库，研究了入院前ICS治疗与COPD患者肺炎住院死亡率之间的关联。
我们回顾性收集了日本1165家医院中接受门诊吸入治疗并因肺炎入院的COPD患者的数据。患者被分为接受ICS联合IBD治疗的患者和仅接受IBD治疗的患者。我们进行了多因素逻辑回归分析，以研究门诊ICS治疗与住院死亡率之间的关联，并对患者背景进行了调整。
在7033例符合条件的患者中，仅接受IBD治疗的组（n = 3331）比接受ICS联合IBD治疗的组（n = 3702）更可能年龄较大、体重指数较低、一般状况较差且肺炎更严重。仅接受IBD治疗组和接受ICS联合IBD治疗组的住院死亡率分别为13.2%和8.1%。在对患者背景进行调整后，接受ICS联合IBD治疗的组的死亡率显著低于仅接受IBD治疗的组（调整后的优势比为0.80；95%置信区间为0.68 - 0.94）。较高的死亡率与年龄较大、男性、体重指数较低、一般状况较差以及肺炎更严重有关。
与仅使用IBD治疗相比，门诊吸入ICS和IBD治疗与COPD患者肺炎死亡率较低显著相关。
