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COPD Exacerbation-Related Pathogens and Previous COPD Treatment
Yun Su Sim1, Jin Hwa Lee2, Eung Gu Lee3
1Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul 07441, Republic of Korea.
Journal of Clinical Medicine
|January 8, 2023
Summary
Medications for chronic obstructive pulmonary disease (COPD) impact infection risk during exacerbations. Systemic steroid use increases Pseudomonas aeruginosa risk, while inhaled corticosteroid use may lower respiratory syncytial virus risk.
Area of Science:
- Pulmonary Medicine
- Infectious Diseases
- Pharmacology
Background:
- Chronic obstructive pulmonary disease (COPD) exacerbations are often triggered by infections.
- Understanding the relationship between prior COPD medication use and pathogens identified during exacerbations is crucial for treatment.
Purpose of the Study:
- To investigate the association between medications used in the 6 months prior to acute exacerbation of COPD (AE-COPD) and the pathogens identified during AE-COPD.
- To determine if inhaled corticosteroid (ICS) or systemic steroid use influences the risk of specific bacterial or viral infections during AE-COPD.
Main Methods:
- Retrospective analysis of medical records from 1177 patients with AE-COPD across 28 hospitals (2008-2019).
- Microorganisms identified during AE-COPD were analyzed based on prior ICS and systemic steroid use, adjusting for COPD severity.
- Statistical analysis included odds ratios (OR) and confidence intervals (CI) to assess risk.
Main Results:
- Bacteria were more frequently identified in patients using ICS (p=0.009) and systemic steroids (p<0.001) compared to non-users.
- Systemic steroid use was associated with a significantly higher risk of Pseudomonas aeruginosa detection during AE-COPD (OR 1.619).
- Inhaled corticosteroid (ICS) use was associated with a lower risk of respiratory syncytial virus (RSV) detection (OR 0.492).
Conclusions:
- COPD patients using systemic steroids prior to AE-COPD face an increased risk of P. aeruginosa infection.
- ICS use may reduce the risk of RSV infection during AE-COPD.
- Anti-pseudomonal antibiotics should be considered for AE-COPD patients with a history of systemic steroid use.
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