Inhaled corticosteroids (ICS) raise the risk of pneumonia in chronic obstructive pulmonary disease (COPD). These are commonly used in patients with COPD-bronchiectasis overlap.
A study published in Chest Journal has concluded an elevated blood eosinophil count appears to protect patients with COPD against an increased risk of pneumonia associated with the use of ICS, particularly in cases where bronchiectasis is also present.
In this study, electronic healthcare records were used to obtain a cohort of patients with COPD and a nested case-control group. Analyses were conducted to determine the hospitalization risk for pneumonia in COPD associated with ICS use in those with Bronchiectasis. The sensitivity analyses confirmed the findings.
The study determined whether the pneumonia risk associated with ICS was further heightened in COPD-bronchiectasis.
Key findings in this study are:
· Three hundred sixteen thousand six hundred sixty-three patients were eligible for the COPD cohort.
· Bronchiectasis significantly increased the risk of pneumonia with an adjusted hazard ratio of 1.24.
· In the first nested case-control group of 84,316 patients with COPD, ICS increased the odds of pneumonia with adjusted OR (AOR) 1.26 only if used in the previous 180 days.
· Bronchiectasis was a significant modifier. ICS use did not augment further the already elevated bronchiectasis-associated pneumonia risk.
· The AOR for COPD-bronchiectasis and no bronchiectasis was 1.01 and 1.27, respectively.
· Several sensitivity analyses and a second smaller nested case-control group confirmed these findings.
· BEC modified the ICS-associated pneumonia risk in COPD-bronchiectasis overlap, where lower BEC was associated significantly with pneumonia.
This study found out if ICS was associated with an elevated risk of pneumonia in people with COPD-bronchiectasis overlap than those with COPD alone.
They said ICS use does not augment further the already increased risk of hospitalization for pneumonia associated with concomitant Bronchiectasis in patients with COPD.
Reference:
Ritchie, A. I., Singayagam, A., Mitchell, S., Wedzicha, J. A., Shah, A., & Bloom, C. (2023). The effect of inhaled corticosteroids on pneumonia risk in patients with COPD-Bronchiectasis overlap. Chest, 164(4), 875–884. https://doi.org/10.1016/j.chest.2023.06.007