Matthew B. Stanbrook, MD, PhD
In older patients with chronic obstructive pulmonary disease (COPD) who are hospitalized for pneumonia, is prior use of inhaled corticosteroids (ICSs) associated with increased mortality?
Retrospective cohort study with linkage of 3 Department of Veterans Affairs (VA) Health Care System databases.
Population-based study in the USA.
15 768 patients ≥ 65 years of age (mean age 77 y, 98% men) who were hospitalized at a VA hospital with a primary discharge diagnosis of pneumonia or a secondary discharge diagnosis of pneumonia with a primary diagnosis of respiratory failure or sepsis; were treated with ≥ 1 dose of antibiotics within 48 hours of hospitalization; had a prior diagnosis of COPD and used ≥ 1 of a β-agonist, theophylline, tiotropium, or ipratropium during the 30 days before hospitalization; and had ≥ 1 year of VA outpatient care before admission. Exclusion criteria included history of asthma and outpatient oral corticosteroid use ≤ 90 days before hospitalization.
Use of ICSs, defined as receipt of prescriptions for ICSs, including inhaled forms of triamcinolone, fluticasone, budesonide, beclomethasone, and flunisolide, ≤ 90 days before hospitalization.
Mortality at 30 and 90 days after first admission. Secondary outcomes were use of invasive mechanical ventilation and vasopressor support during hospitalization.
53% of patients received ICSs ≤ 90 days before hospitalization. Of these, 51% used flunisolide, 28% used fluticasone, and 20% used triamcinolone. Patients who used ICSs had reduced risk for 30- and 90-day mortality and mechanical ventilation; groups did not differ for vasopressor support during hospitalization (Table).
In older patients with chronic obstructive pulmonary disease who were hospitalized for pneumonia, prior use of inhaled corticosteroids was associated with reduced mortality.
*CI defined in Glossary. Adjusted for age, sex, race, marital status, socioeconomic status, medication class, nursing home status, current tobacco use, Charlson composite score, intensive care unit admission, and receipt of guideline-concordant antibiotics.
Stanbrook MB. Prior use of inhaled corticosteroids was associated with less mortality in elders with COPD and pneumonia. Ann Intern Med. ;156:JC2–12. doi: 10.7326/0003-4819-156-4-201202210-02012
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Published: Ann Intern Med. 2012;156(4):JC2-12.
Chronic Obstructive Airway Disease, Infectious Disease, Pneumonia, Pulmonary/Critical Care.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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