PURPOSE:Inhaled corticosteroids (ICS) are commonly prescribed for patients with chronic obstructive pulmonary disease (COPD). Recent studies have shown an increased risk of pneumonia in those using ICS; however, studies are lacking in newly diagnosed COPD patients.
METHODS:A nested case-control study was conducted using Veterans Health Administration (VA) and Medicare databases. From October 1998 to September 2004, patients with a new COPD diagnosis who were 65 years of age or older were identified and followed through September 2005. Patients with a pneumonia hospitalization (index date) were identified as cases and matched on age, sex, month, year and region to up to 10 controls. ICS exposure within six months preceding the index date was determined. The association between ICS and pneumonia was assessed using conditional logistic regression, adjusting for comorbidities, healthcare utilization, and respiratory medication use.
RESULTS:We identified 46,741 cases of pneumonia matched to 174,110 controls. The average age was 74.2 (SD=5.7) years and 99.7% were male. The unadjusted OR for pneumonia hospitalization associated with ICS exposure was 1.43 (95% CI, 1.38–1.49), while there was no significant association after adjustment (Adjusted OR 0.98 [95% CI, 0.93–1.03]). In the adjusted analysis, the odds of pneumonia were much higher in patients with a COPD exacerbation at baseline (OR=1.72 [1.71–1.74]).
CONCLUSION:Among elderly patients with newly diagnosed COPD, the use of ICS was not associated with increased odds of having a hospitalization for pneumonia compared to those without ICS exposure. However, previous COPD exacerbations were associated with an increased likelihood of pneumonia.
CLINICAL IMPLICATIONS:In elderly patients with newly diagnosed COPD, pneumonia is not associated with the use of ICS. Use of ICS in a patient with existing COPD may confer different risks than ICS use in patients with a new diagnosis of COPD.
DISCLOSURE:Min Joo, No Financial Disclosure Information; No Product/Research Disclosure Information