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. 2019 Jun-Jul;51(6):333-340.
doi: 10.1016/j.aprim.2018.02.007. Epub 2018 Apr 13.

[Community-acquired pneumonia in patients with chronic obstructive pulmonary disease treated with inhaled corticosteroids or other bronchodilators. Study PNEUMOCORT]

[Article in Spanish]
Rosa Morros  1 , Cristina Vedia  2 , Maria Giner-Soriano  1 , Aina Casellas  3 , Ester Amado  4 , Jose Miguel Baena  5 ; en representación de los investigadores del proyecto PNEUMOCORT
Affiliations

[Community-acquired pneumonia in patients with chronic obstructive pulmonary disease treated with inhaled corticosteroids or other bronchodilators. Study PNEUMOCORT]

[Article in Spanish]
Rosa Morros et al. Aten Primaria. 2019 Jun-Jul.

Abstract
in English, Spanish

Objectives: To analyse the risk of pneumonia and/or exacerbations in patients with chronic obstructive pulmonary disease (COPD) who receive treatment with inhaled corticosteroids (CI), in comparison with those who are not treated with inhaled corticosteroids (NCI). To estimate the risk of pneumonia according to CI dose.

Design: Population-based cohort study.

Setting: Primary Healthcare. Institut Català de la Salut.

Participants: Patients ≥45 years-old diagnosed with COPD between 2007 and 2009 in the Information System for Research in Primary Care (SIDIAP).

Intervention: Two cohorts; patients initiating CI and patients initiating bronchodilators after COPD diagnosis.

Main measurements: Demographics, smoking, medical history, pneumonias, exacerbations, vaccinations, and drug therapy.

Results: A total of 3,837 patients were included, 58% in the CI and 42% in the NCI group. Higher incidence rates of pneumonia and exacerbations were detected in the CI group compared with the NCI (2.18 vs. 1.37). The risk of pneumonia and severe exacerbations was not significantly different between groups, HR; 1.17 (95% CI; 0.87-1.56) and 1.06 (95% CI; 0.87-1.31), respectively. Patients in the CI group had a higher risk of mild exacerbations, HR; 1.28 (95% CI; 1.10-1.50). Variables associated with a higher risk of pneumonia were age, diabetes, previous pneumonias and bronchitis, very severe COPD, treatment with low doses of β2-adrenergic or anticholinergic agents, and previous treatment with oral corticosteroids.

Conclusions: There were no differences between cohorts in the risk of pneumonia and severe exacerbations. The risk of mild exacerbations was higher in the CI group. Pneumonias and severe exacerbations were more frequent in patients with severe COPD and in patients receiving high doses of CI.

Objetivos: Analizar el riesgo de neumonía y/o exacerbaciones en pacientes con enfermedad pulmonar obstructiva crónica (EPOC) tratados con corticoides inhalados (CI) y no tratados con CI (NCI). Estimar el riesgo de neumonía según la dosis de CI.

Diseño: Estudio de cohortes de base poblacional.

Emplazamiento: Atención Primaria. Institut Català de la Salut.

Participantes: Pacientes ≥ 45 años diagnosticados de EPOC entre 2007 y 2009 en el Sistema de Información para el Desarrollo de la Investigación en Atención Primaria (SIDIAP).

Intervención: Dos cohortes; pacientes que inician CI y pacientes que inician broncodilatadores NCI después del diagnóstico de EPOC.

Mediciones principales: Sociodemográficas, tabaquismo, antecedentes patológicos, neumonías, exacerbaciones, vacunaciones y tratamientos farmacológicos.

Resultados: Se incluyeron 3.837 pacientes: el 58% en el grupo CI y el 42% en el grupo NCI. Se detectaron incidencias superiores de neumonía y exacerbaciones en el grupo CI respecto al NCI (2,18 vs. 1,37). El riesgo de neumonía y de exacerbaciones graves no fue significativamente diferente entre grupos: HR de 1,17 (IC 95%: 0,87-1,56) y de 1,06 (IC 95%: 0,87-1,31), respectivamente. En el grupo CI presentaron mayor riesgo de exacerbaciones leves, con HR de 1,28 (IC 95%: 1,10-1,50). Las variables asociadas a mayor riesgo de neumonías fueron: edad, diabetes, neumonías y bronquitis previas, EPOC muy grave, tratamiento con β2-adrenérgicos o anticolinérgicos a dosis bajas, y tratamiento previo con corticoides orales.

Conclusiones: No hubo diferencias entre cohortes en el riesgo de NAC ni exacerbaciones graves. Las exacerbaciones leves fueron superiores en el grupo CI. Tanto NAC como exacerbaciones graves fueron más frecuentes en pacientes con EPOC grave y en pacientes tratados con dosis altas de CI.

Keywords: Bronchodilators; Broncodilatadores; COPD; Corticoides inhalados; EPOC; Exacerbaciones; Exacerbations; Inhaled corticosteroids; Neumonía; Pneumonia.

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Figures

None
Esquema del estudio. Estudio de cohortes para analizar el riesgo de neumonía y/o exacerbaciones en pacientes con enfermedad pulmonar obstructiva crónica (EPOC) tratados con corticoides inhalados (CI) y no tratados con CI (NCI).
Figura 1
Figura 1
Tiempo hasta la aparición del primer episodio de neumonía.
Figura 2
Figura 2
Incidencia de neumonía y exacerbaciones según dosis de corticoides inhalados durante el periodo de estudio. IC: intervalo de confianza; CI: corticoides inhalados; NAC: neumonías adquiridas en la comunidad.
See this image and copyright information in PMC

References

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