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The Effect of Inhaled Corticosteroids on Pneumonia Risk in Patients With COPD-Bronchiectasis Overlap: A UK
Andrew I Ritchie1, Aran Singayagam2, Sebastian Mitchell1
1National Heart and Lung Institute, Imperial College London, London, England.
Chest
|July 7, 2023
Summary
Inhaled corticosteroids (ICS) do not increase pneumonia risk in COPD patients who also have bronchiectasis. Bronchiectasis itself significantly raises pneumonia risk, but adding ICS does not further elevate this risk.
Area of Science:
- Pulmonology
- Clinical Medicine
- Epidemiology
Background:
- Inhaled corticosteroids (ICS) are frequently prescribed for COPD patients, including those with co-existing bronchiectasis.
- ICS use is associated with an increased risk of pneumonia in patients with COPD.
Purpose of the Study:
- To investigate whether the risk of pneumonia associated with ICS is further heightened in patients with COPD-bronchiectasis overlap.
- To evaluate the modifying effect of bronchiectasis on the association between ICS use and pneumonia risk in COPD patients.
Main Methods:
- A large cohort study using electronic health records (2004-2019) of COPD patients.
- Nested case-control analyses were performed to assess pneumonia hospitalization risk.
- Sensitivity analyses and a subgroup analysis including blood eosinophil counts (BEC) were conducted.
Main Results:
- Bronchiectasis significantly increased the risk of pneumonia in COPD patients (aHR=1.24).
- ICS use increased pneumonia odds only when used within 180 days.
- However, bronchiectasis attenuated the effect of ICS on pneumonia risk (AOR=1.01 in COPD-bronchiectasis vs. 1.27 without bronchiectasis).
- Lower blood eosinophil counts (BEC ≤ 3 × 10^9/L) were associated with increased pneumonia risk in COPD-bronchiectasis overlap (AOR=1.56).
Conclusions:
- In patients with COPD and bronchiectasis overlap, inhaled corticosteroid use does not further increase the already elevated risk of pneumonia.
- Bronchiectasis appears to modify the risk associated with ICS, diminishing its impact on pneumonia incidence.
- Blood eosinophil levels may play a role in modulating pneumonia risk in this patient population.
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