Section of Respiratory Medicine, Department of Medicine, Copenhagen University Hospital Herlev and Gentofte Hospital, Hellerup, Denmark.
Department of Respiratory Medicine and Infectious Diseases, Copenhagen University Hospital-North Zealand, Hillerød, Denmark.
BMJ Open Respir Res. 2023 Sep;10(1). doi: 10.1136/bmjresp-2023-001814.
Inhaled corticosteroids (ICSs) are associated with an increased risk of pneumonia among patients with chronic obstructive pulmonary disease (COPD). The introduction of extrafine particle ICS has aimed to improve the distribution of medicine in the airways by altering deposition within the lungs, potentially affecting efficacy and side effects. It remains unclear if extrafine particle ICS administration alters the risk of pneumonia compared with standard particle size ICS.
An observational cohort study including all Danish COPD outpatients receiving ICS from 2010 to 2017. The primary outcome was pneumonia hospitalisation in the different ICS particle dosing regimens. The primary analysis was an adjusted Cox proportional hazards model. For sensitivity analysis, a subgroup analysis of patients receiving spray devices was done. Further, we created a propensity score matched cohort, in which we matched for the same covariates as adjusted for in the main analysis.
A total of 35 691 patients were included of whom 1471 received extrafine particle ICS. Among these patients, 4657 were hospitalised due to pneumonia. Patients with COPD receiving extrafine particle ICS had a lower risk of hospitalisation due to pneumonia compared with patients receiving standard particle size ICS in our primary analysis (HR 0.75; 95% CI 0.63 to 0.89; p=0.002), subgroup analysis (HR 0.54; 95% CI 0.45 to 0.65; p<0.0001) and the propensity-matched population (HR 0.72; 95% CI 0.60 to 0.87; p=0.0006).
The use of extrafine particle ICS administration was associated with a lower risk of pneumonia hospitalisation in patients with COPD compared with those who received standard size treatment.
吸入性皮质类固醇（ICSs）会增加慢性阻塞性肺疾病（COPD）患者发生肺炎的风险。超细颗粒 ICS 的应用旨在通过改变肺部内的沉积来改善药物在气道中的分布，从而可能影响疗效和副作用。目前尚不清楚超细颗粒 ICS 的给药是否会改变与标准颗粒大小 ICS 相比发生肺炎的风险。
这是一项观察性队列研究，纳入了 2010 年至 2017 年期间所有接受 ICS 治疗的丹麦 COPD 门诊患者。主要结局是不同 ICS 颗粒剂量方案下的肺炎住院情况。主要分析采用校正 Cox 比例风险模型。进行敏感性分析时，对使用喷雾装置的患者进行亚组分析。此外，我们创建了一个倾向评分匹配队列，在该队列中，我们针对与主要分析中调整的相同协变量进行了匹配。
共纳入 35691 例患者，其中 1471 例接受超细颗粒 ICS 治疗。在这些患者中，有 4657 例因肺炎住院。在我们的主要分析（HR 0.75；95%CI 0.63 至 0.89；p=0.002）、亚组分析（HR 0.54；95%CI 0.45 至 0.65；p<0.0001）和倾向评分匹配人群（HR 0.72；95%CI 0.60 至 0.87；p=0.0006）中，接受超细颗粒 ICS 治疗的 COPD 患者因肺炎住院的风险均低于接受标准颗粒治疗的患者。
与接受标准剂量治疗的患者相比，COPD 患者使用超细颗粒 ICS 治疗与肺炎住院风险降低相关。
