Section of Respiratory Medicine, Department of Medicine, Herlev-Gentofte Hospital, University of Copenhagen, Gentofte, Denmark.
Department of Clinical Microbiology, Herlev-Gentofte Hospital, Herlev, Denmark.
BMJ Open Respir Res. 2023 Aug;10(1). doi: 10.1136/bmjresp-2023-001726.
Use of inhaled corticosteroids (ICS) is common in patients with chronic obstructive pulmonary disease (COPD) and has been associated with an increased risk of pneumonia. is one of the most common bacterial causes of infectious exacerbation in COPD. Currently, to our knowledge, no studies have investigated if ICS increases the risk of lower respiratory tract infection with in patients with COPD.
To investigate if accumulated ICS use in patients with COPD, is associated with a dose-dependent risk of infection with .
This observational cohort study included 18 870 persons with COPD who were registered in The Danish Register of COPD. Linkage to several nationwide registries was performed.Exposure to ICS was determined by identifying all prescriptions for ICS, redeemed within 365 days prior to study entry. Main outcome was a lower respiratory tract sample positive for . For the main analysis, a Cox multivariate regression model was used.We defined clinical infection as admission to hospital and/or a redeemed prescription for a relevant antibiotic, within 7 days prior to 14 days after the sample was obtained.
We found an increased, dose-dependent, risk of a lower respiratory tract sample with among patients who used ICS, compared with non-users. For low and moderate doses of ICS HR was 1.65 (95% CI 1.19 to 2.30, p=0.003) and 1.82 (95% CI 1.32 to 2.51, p=0.0002), respectively. In the group of patients with highest ICS exposure, the HR of was 2.80 (95% CI 2.06 to 3.82, p<0.0001). Results remained stable in sensitivity analyses. 87% of patients fulfilled the criteria for clinical infection, and results remained unchanged in this population.
Our study shows a dose-dependent increased risk of infection with associated to ICS exposure.
在慢性阻塞性肺疾病（COPD）患者中，使用吸入性皮质类固醇（ICS）很常见，并且与肺炎风险增加有关。铜绿假单胞菌是 COPD 感染性加重的最常见细菌病原体之一。目前，据我们所知，尚无研究调查 ICS 是否会增加 COPD 患者下呼吸道感染铜绿假单胞菌的风险。
调查 COPD 患者累积 ICS 使用与铜绿假单胞菌感染的剂量依赖性风险。
本观察性队列研究纳入了 18870 名在丹麦 COPD 登记处登记的 COPD 患者。通过与多个全国性登记处进行链接，确定了 ICS 的暴露情况。通过识别在研究入组前 365 天内开具的所有 ICS 处方来确定 ICS 的暴露情况。主要结局是下呼吸道样本中存在铜绿假单胞菌。对于主要分析，我们使用了 Cox 多变量回归模型。我们将临床感染定义为在获得样本前 7 天至后 14 天内住院和/或开具相关抗生素处方。
与非使用者相比，使用 ICS 的患者下呼吸道样本中铜绿假单胞菌的风险呈剂量依赖性增加。对于低剂量和中剂量 ICS，HR 分别为 1.65（95%CI 1.19 至 2.30，p=0.003）和 1.82（95%CI 1.32 至 2.51，p=0.0002）。在 ICS 暴露最高的患者组中，铜绿假单胞菌的 HR 为 2.80（95%CI 2.06 至 3.82，p<0.0001）。敏感性分析结果仍然稳定。87%的患者符合临床感染标准，该人群的结果仍然不变。
我们的研究表明，与 ICS 暴露相关，铜绿假单胞菌感染的风险呈剂量依赖性增加。
