Miravitlles Marc, Auladell-Rispau Ariadna, Monteagudo Mònica, Vázquez-Niebla Juan Carlos, Mohammed Jibril, Nuñez Alexa, Urrútia Gerard
Pneumology Dept, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
Both authors contributed equally and are considered first authors.
Eur Respir Rev. 2021 Jun 23;30(160). doi: 10.1183/16000617.0075-2021. Print 2021 Jun 30.
Inhaled corticosteroids (ICSs) are indicated for the prevention of exacerbations in COPD; however, a significant proportion of patients at low risk of exacerbations are treated with ICSs. We conducted a systematic review including a diversity of types of study designs and safety outcomes with the objective of describing the risk of adverse effects associated with the long-term use of ICSs in patients with COPD.A total of 90 references corresponding to 83 studies were included, including 26 randomised clinical trials (RCTs), 33 cohort studies, and 24 nested case-control (NCC) studies. Analysis of 19 RCTs showed that exposure to ICSs for ≥1 year increased the risk of pneumonia by 41% (risk ratio 1.41, 95% CI 1.23-1.61). Additionally, cohort and NCC studies showed an association between ICSs and risk of tuberculosis and mycobacterial disease. There was a strong association between ICS use and local disorders such as oral candidiasis and dysphonia. The association between ICSs and the risk of diabetes and fractures was less clear and appeared significant only at high doses of ICSs.Since most patients with COPD are elderly and with frequent comorbidities, an adequate risk-benefit balance is crucial for the indication of ICSs.
吸入性糖皮质激素（ICSs）被用于预防慢性阻塞性肺疾病（COPD）的急性加重；然而，相当一部分急性加重低风险的患者也接受了ICSs治疗。我们进行了一项系统评价，纳入了多种研究设计类型和安全性结局，目的是描述COPD患者长期使用ICSs相关的不良反应风险。
总共纳入了与83项研究对应的90篇参考文献，包括26项随机临床试验（RCTs）、33项队列研究和24项巢式病例对照（NCC）研究。对19项RCTs的分析表明，暴露于ICSs≥1年使肺炎风险增加41%（风险比1.41，95%CI 1.23 - 1.61）。此外，队列研究和NCC研究表明ICSs与结核病和分枝杆菌病风险之间存在关联。ICS使用与口腔念珠菌病和发音障碍等局部疾病之间存在强关联。ICSs与糖尿病和骨折风险之间的关联不太明确，仅在高剂量ICSs时才显得显著。
由于大多数COPD患者为老年人且常伴有合并症，对于ICSs的使用，充分的风险效益平衡至关重要。
