Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden.
Population Health and Occupational Disease, National Heart and Lung Institute, Imperial College, London, UK.
BMC Pulm Med. 2019 Dec 19;19(1):254. doi: 10.1186/s12890-019-1025-1.
Pneumonia is an important cause of morbidity and mortality. COPD patients using inhaled corticosteroids (ICS) have an increased risk of pneumonia, but less is known about whether ICS treatment in asthma also increases the risk of pneumonia. The aim of this analysis was to examine risk factors for hospitalisations with pneumonia in a general population sample with special emphasis on asthma and the use of ICS in asthmatics.
In 1999 to 2000, 7340 subjects aged 28 to 54 years from three Swedish centres completed a brief health questionnaire. This was linked to information on hospitalisations with pneumonia from 2000 to 2010 and treatment with ICS from 2005 to 2010 held within the Swedish National Patient Register and the Swedish Prescribed Drug Register.
Participants with asthma (n = 587) were more likely to be hospitalised with pneumonia than participants without asthma (Hazard Ratio (HR 3.35 (1.97-5.02)). Other risk factors for pneumonia were smoking (HR 1.93 (1.22-3.06)), BMI < 20 kg/m2 (HR 2.74 (1.41-5.36)) or BMI > 30 kg/m2 (HR 2.54 (1.39-4.67)). Asthmatics (n = 586) taking continuous treatment with fluticasone propionate were at an increased risk of being hospitalized with pneumonia (incidence risk ratio (IRR) 7.92 (2.32-27.0) compared to asthmatics that had not used fluticasone propionate, whereas no significant association was found with the use of budesonide (IRR 1.23 (0.36-4.20)).
Having asthma is associated with a three times higher risk of being hospitalised for pneumonia. This analysis also indicates that there are intraclass differences between ICS compounds with respect to pneumonia risk, with an increased risk of pneumonia related to fluticasone propionate.
肺炎是发病率和死亡率的重要原因。使用吸入性皮质类固醇（ICS）的 COPD 患者发生肺炎的风险增加，但对于哮喘患者中 ICS 治疗是否也会增加肺炎风险知之甚少。本分析的目的是在一般人群样本中检查肺炎住院的危险因素，特别强调哮喘和哮喘患者使用 ICS。
1999 年至 2000 年，来自瑞典三个中心的 7340 名 28 至 54 岁的受试者完成了一份简短的健康问卷。该问卷与 2000 年至 2010 年期间的肺炎住院信息以及 2005 年至 2010 年期间瑞典国家患者登记处和瑞典处方药物登记处中记录的 ICS 治疗情况相关联。
患有哮喘的参与者（n=587）比没有哮喘的参与者（HR 3.35（1.97-5.02））更有可能因肺炎住院。肺炎的其他危险因素包括吸烟（HR 1.93（1.22-3.06））、BMI<20kg/m2（HR 2.74（1.41-5.36））或 BMI>30kg/m2（HR 2.54（1.39-4.67））。连续接受丙酸氟替卡松治疗的哮喘患者（n=586）因肺炎住院的风险增加（与未使用丙酸氟替卡松的哮喘患者相比，发生率风险比（IRR）为 7.92（2.32-27.0）），而与使用布地奈德（IRR 1.23（0.36-4.20））之间未发现显著相关性。
患有哮喘与肺炎住院风险增加三倍相关。本分析还表明，ICS 化合物之间存在肺炎风险的类内差异，与肺炎相关的丙酸氟替卡松风险增加。
