Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.
Department of Biostatistics, Yonsei University, Seoul, Korea.
Int J Chron Obstruct Pulmon Dis. 2021 Nov 25;16:3229-3237. doi: 10.2147/COPD.S332151. eCollection 2021.
Inhaled corticosteroids (ICSs) play an important role in lowering the risk of acute exacerbation of chronic obstructive pulmonary disease (COPD). However, ICSs are known to increase the risk of pneumonia. Moreover, previous studies have shown that the incidence rate of pneumonia varies depending on the type of ICS. In this study, the risk of pneumonia according to the type of ICS was investigated in a population-based cohort.
A retrospective cohort study was conducted using claims data of the entire population from the Korean National Health Insurance Service. Patients who were newly diagnosed with COPD and prescribed fluticasone propionate or budesonide were enrolled as study subjects. Cumulative doses of ICSs were classified into categorical variables to analyze the risk of pneumonia within identical ICS doses.
A total of 47,473 subjects were identified and allocated as 14,518 fluticasone propionate and 14,518 budesonide users through 1:1 propensity score matching. Fluticasone propionate users were more likely to develop pneumonia than budesonide users (14.22% vs 10.66%, p<0.0001). The incidence rate per 100,000 person-years was 2,914.77 for fluticasone propionate users and 2,102.90 for budesonide users. The hazard ratio (HR) of pneumonia in fluticasone propionate compared to budesonide was 1.34 (95% CI 1.26-1.43, p<0.0001). The risk of pneumonia for fluticasone propionate compared to budesonide increased with higher ICS cumulative doses: 1.06 (0.93-1.21), 1.41 (1.19-1.66), 1.41 (1.23-1.63), and 1.49 (1.33-1.66) from the lowest to highest quartiles, respectively.
ICS types and doses need to be carefully considered during treatment with ICSs in patients with COPD.
吸入性皮质类固醇（ICSs）在降低慢性阻塞性肺疾病（COPD）急性加重的风险方面发挥着重要作用。然而，ICSs 已知会增加肺炎的风险。此外，先前的研究表明，肺炎的发病率因 ICS 的类型而异。在这项基于人群的队列研究中，我们调查了根据 ICS 类型发生肺炎的风险。
使用韩国国家健康保险服务的整个人群的索赔数据进行回顾性队列研究。将新诊断为 COPD 并开具丙酸氟替卡松或布地奈德的患者纳入研究对象。ICS 剂量的累积剂量被分类为分类变量，以分析相同 ICS 剂量范围内肺炎的风险。
共确定了 47473 名患者，并通过 1:1 倾向评分匹配将其分为 14518 名丙酸氟替卡松和 14518 名布地奈德使用者。丙酸氟替卡松使用者比布地奈德使用者更容易发生肺炎（14.22%比 10.66%，p<0.0001）。丙酸氟替卡松使用者每 100000 人年的发病率为 2914.77，而布地奈德使用者为 2102.90。丙酸氟替卡松与布地奈德相比，肺炎的危害比（HR）为 1.34（95%置信区间 1.26-1.43，p<0.0001）。与布地奈德相比，丙酸氟替卡松的肺炎风险随着 ICS 累积剂量的增加而增加：从最低到最高四分位数分别为 1.06（0.93-1.21）、1.41（1.19-1.66）、1.41（1.23-1.63）和 1.49（1.33-1.66）。
在 COPD 患者使用 ICS 治疗时，需要仔细考虑 ICS 的类型和剂量。
