识别 COPD 患者肺炎的相关风险：ARCTIC 观察性研究。
Identifying the associated risks of pneumonia in COPD patients: ARCTIC an observational study.
机构信息
Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Akademiska sjukhuset, 75185, Uppsala, Sweden.
Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden.
出版信息
Respir Res. 2018 Sep 10;19(1):172. doi: 10.1186/s12931-018-0868-y.
BACKGROUND
Inhaled corticosteroids (ICS) are associated with an increased risk of pneumonia in patients with chronic obstructive pulmonary disease (COPD). Other factors such as severity of airflow limitation and concurrent asthma may further raise the possibility of developing pneumonia. This study assessed the risk of pneumonia associated with ICS in patients with COPD.
METHODS
Electronic Medical Record data linked to National Health Registries were collected from COPD patients and matched reference controls in 52 Swedish primary care centers (2000-2014). Levels of ICS treatment (high, low, no ICS) and associated comorbidities were assessed. Patients were categorized by airflow limitation severity.
RESULTS
A total of 6623 patients with COPD and 48,566 controls were analyzed. Patients with COPD had a more than 4-fold increase in pneumonia versus reference controls (hazard ratio [HR] 4.76, 95% confidence interval [CI]: 4.48-5.06). ICS use increased the risk of pneumonia by 20-30% in patients with COPD with forced expiratory volume in 1 s ≥ 50% versus patients not using ICS. Asthma was an independent risk factor for pneumonia in the COPD population. Multivariate analysis identified independent predictors of pneumonia in the overall population. The highest risk of pneumonia was associated with high dose ICS (HR 1.41, 95% CI: 1.23-1.62).
CONCLUSIONS
Patients with COPD have a greater risk of pneumonia versus reference controls; ICS use and concurrent asthma increased the risk of pneumonia further.
背景
吸入性皮质类固醇（ICS）会增加慢性阻塞性肺疾病（COPD）患者患肺炎的风险。其他因素，如气流受限的严重程度和同时存在的哮喘，可能会进一步增加患肺炎的可能性。本研究评估了 COPD 患者使用 ICS 与肺炎相关的风险。
方法
从 52 家瑞典初级保健中心（2000-2014 年）的 COPD 患者和匹配的参考对照中收集了与国家健康登记相关的电子病历数据。评估了 ICS 治疗水平（高、低、无 ICS）和相关合并症。根据气流受限严重程度对患者进行分类。
结果
共分析了 6623 例 COPD 患者和 48566 例对照。与参考对照相比，COPD 患者肺炎的发生率增加了 4 倍以上（风险比 [HR] 4.76，95%置信区间 [CI]：4.48-5.06）。与未使用 ICS 的 COPD 患者相比，使用 ICS 的患者肺炎风险增加 20-30%，且 1 秒用力呼气量（FEV1）≥50%。哮喘是 COPD 患者肺炎的独立危险因素。多变量分析确定了总体人群中肺炎的独立预测因素。高剂量 ICS 与肺炎的相关性最高（HR 1.41，95% CI：1.23-1.62）。
结论
与参考对照相比，COPD 患者患肺炎的风险更高；ICS 的使用和同时存在的哮喘进一步增加了患肺炎的风险。
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