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Comparative Study
. 2017 Jun;195(3):281-288.
doi: 10.1007/s00408-017-9990-8. Epub 2017 Mar 3.

Inhaled Corticosteroid use and the Risk of Pneumonia and COPD Exacerbations in the UPLIFT Study

Jaymin B Morjaria  1   2 , Alan Rigby  1 , Alyn H Morice  3
Affiliations
Comparative Study

Inhaled Corticosteroid use and the Risk of Pneumonia and COPD Exacerbations in the UPLIFT Study

Jaymin B Morjaria et al. Lung. 2017 Jun.

Abstract

Rationale: Unlike many other COPD studies, the 4-year UPLIFT trial permitted inhaled corticosteroid (ICS) use during run-in and treatment phases. This provided the opportunity to prospectively observe the continuing effects of ICS on respiratory events in closely observed COPD population.

Objectives: We aimed to determine rate and number of episodes of pneumonia and exacerbations of COPD in patients entering the study on no ICS, fluticasone proprionate (FP), and other ICS.

Methods: The UPLIFT dataset was examined retrospectively, and patients were divided into three groups based on their medications at entry: no ICS, FP and other ICS. Poisson regression was used to compare the frequency of respiratory adverse events.

Measurements and main results: At entry, the groups were well matched apart from a higher FEV1% predicted (38 vs. 41%; ICS vs. no ICS, respectively) and prevalence of current smoking (26 vs. 36%; ICS vs. no ICS, respectively). Incidence rates of pneumonia were significantly higher in patients taking ICS compared to no ICS (0.068 vs. 0.056 respectively; p = 0.012). When the FP group was compared to the other ICS, the event rate was even higher (0.077 vs. 0.058, respectively; p < 0.001). COPD exacerbations were more frequent in patients taking ICS, with significantly greater rate in the FP group compared to that seen with other ICS (0.93 vs. 0.84 respectively; p = 0.013).

Conclusions: ICS use was associated an increase in respiratory adverse event rates, but whether this was due to more severe illness at entry is unknown. In subgroup analysis, the excess of morbidity in the ICS group appeared to be mainly associated with those receiving FP at randomisation.

Keywords: COPD; Fluticasone; Inhaled corticosteroids; Pneumonia; Tiotropium; UPLIFT.

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Conflict of interest statement

Conflict of interest

JBM has received honoraria for speaking and financial support to attend meetings/ advisory boards from Wyeth, Chiesi, Pfizer, MSD, Boerhinger Ingelheim, Teva, GlaxoSmithKline, Napp, Almirall, AstraZeneca and Novartis Pharmaceuticals UK. ASR has no declarations. AHM has received for speaking and financial support to attend meetings/ advisory boards and grants from Boerhinger Ingelheim, Chiesi, Novartis Pharmaceuticals UK, Almirall, Astra Zeneca, GlaxoSmithKline, Reckitt Benckiser, Nexus Communications Group, Pfizer Ltd, Bayer plc, Infirst Healthcare, Afferent Pharmaceuticals Inc, Philips Home Healthcare Solutions, Nycomed, Aerocrine AB, Roche, Genentech, ICON and Patara Pharma.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. (UPLIFT clinical Trial registration NCT00144339).

Figures

Fig. 1
Fig. 1
a Time-to-1st pneumonia event: ICS versus no ICS. b Time-to-first pneumonia event: Fluticasone versus other ICS vs no ICS
Fig. 2
Fig. 2
Time-to-1st COPD exacerbation: Fluticasone versus other ICS versus no ICS
See this image and copyright information in PMC

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