Mohsin Raza Ul, Heerfordt Christian Kjer, Eklöf Josefin, Sivapalan Pradeesh, Saeed Mohamad Isam, Ingebrigtsen Truls Sylvan, Nielsen Susanne Dam, Harboe Zitta Barrella, Iversen Kasper Karmark, Bangsborg Jette, Jarløv Jens Otto, Boel Jonas Bredtoft, Østergaard Andersen Christian, Calum Henrik Pierre, Dessau Ram B, Jensen Jens-Ulrik Stæhr
Department of Internal Medicine, Section of Respiratory Medicine, Herlev and Gentofte Hospital, University of Copenhagen, 2900 Hellerup, Denmark.
PERSIMUNE & CHIP, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, 2100 Copenhagen, Denmark.
J Clin Med. 2022 Jun 20;11(12):3539. doi: 10.3390/jcm11123539.
Background: Inhaled corticosteroids (ICS) are widely used in chronic obstructive pulmonary disease (COPD), despite the known risk of severe adverse effects including pulmonary infections. Research Question: Our study investigates the risk of acquiring a positive Haemophilus influenzae airway culture with use of ICS in outpatients with COPD. Study Design and Methods: We conducted an epidemiological cohort study using data from 1 January 2010 to 19 February 2018, including 21,218 outpatients with COPD in Denmark. ICS use 365 days prior to cohort entry was categorised into low, moderate, and high, based on cumulated ICS dose extracted from a national registry on reimbursed prescriptions. A Cox proportional hazards regression model was used to assess the future risk of acquiring H. Influenzae within 365 days from cohort entry, and sensitivity analyses were performed using propensity score matched models. Results: In total, 801 (3.8%) patients acquired H. Influenzae during follow-up. Use of ICS was associated with a dose-dependent increased risk of acquiring H. Influenzae with hazard ratio (HR) 1.2 (95% confidence interval (CI) 0.9−1.5, p value = 0.1) for low-dose ICS; HR 1.7 (95% CI 1.3−2.1, p value < 0.0001) for moderate dose; and HR 1.9 (95% CI 1.5−2.4, p value < 0.0001) for high-dose ICS compared to no ICS use. Results were confirmed in the propensity-matched model using the same categories. Conclusions: ICS use in outpatients with COPD was associated with a dose-dependent increase in risk of isolating H. Influenzae. This observation supports that high dose ICS should be used with caution.
吸入性糖皮质激素（ICS）广泛应用于慢性阻塞性肺疾病（COPD），尽管已知其存在包括肺部感染在内的严重不良反应风险。研究问题：我们的研究调查了COPD门诊患者使用ICS后获得流感嗜血杆菌气道培养阳性的风险。研究设计与方法：我们利用丹麦2010年1月1日至2018年2月19日的数据进行了一项流行病学队列研究，纳入了21,218例COPD门诊患者。根据从国家报销处方登记处提取的累积ICS剂量，将队列入组前365天的ICS使用情况分为低、中、高剂量。采用Cox比例风险回归模型评估队列入组后365天内获得流感嗜血杆菌的未来风险，并使用倾向评分匹配模型进行敏感性分析。结果：总共801例（3.8%）患者在随访期间获得流感嗜血杆菌。使用ICS与获得流感嗜血杆菌的风险呈剂量依赖性增加相关，低剂量ICS的风险比（HR）为1.2（95%置信区间（CI）0.9 - 1.5，p值 = 0.1）；中剂量HR为1.7（95%CI 1.3 - 2.1，p值 < 0.0001）；高剂量ICS与未使用ICS相比，HR为1.9（95%CI 1.5 - 2.4，p值 < 0.0001）。在使用相同分类的倾向匹配模型中结果得到证实。结论：COPD门诊患者使用ICS与分离出流感嗜血杆菌的风险呈剂量依赖性增加相关。这一观察结果支持应谨慎使用高剂量ICS。
