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Observational Study
. 2018 Sep 10;19(1):172.
doi: 10.1186/s12931-018-0868-y.

Identifying the associated risks of pneumonia in COPD patients: ARCTIC an observational study

Christer Janson  1 , Gunnar Johansson  2 , Björn Ställberg  2 , Karin Lisspers  2 , Petter Olsson  3 , Dorothy L Keininger  4 , Milica Uhde  5 , Florian S Gutzwiller  4 , Leif Jörgensen  6 , Kjell Larsson  7
Affiliations
Observational Study

Identifying the associated risks of pneumonia in COPD patients: ARCTIC an observational study

Christer Janson et al. Respir Res. .

Abstract

Background: Inhaled corticosteroids (ICS) are associated with an increased risk of pneumonia in patients with chronic obstructive pulmonary disease (COPD). Other factors such as severity of airflow limitation and concurrent asthma may further raise the possibility of developing pneumonia. This study assessed the risk of pneumonia associated with ICS in patients with COPD.

Methods: Electronic Medical Record data linked to National Health Registries were collected from COPD patients and matched reference controls in 52 Swedish primary care centers (2000-2014). Levels of ICS treatment (high, low, no ICS) and associated comorbidities were assessed. Patients were categorized by airflow limitation severity.

Results: A total of 6623 patients with COPD and 48,566 controls were analyzed. Patients with COPD had a more than 4-fold increase in pneumonia versus reference controls (hazard ratio [HR] 4.76, 95% confidence interval [CI]: 4.48-5.06). ICS use increased the risk of pneumonia by 20-30% in patients with COPD with forced expiratory volume in 1 s ≥ 50% versus patients not using ICS. Asthma was an independent risk factor for pneumonia in the COPD population. Multivariate analysis identified independent predictors of pneumonia in the overall population. The highest risk of pneumonia was associated with high dose ICS (HR 1.41, 95% CI: 1.23-1.62).

Conclusions: Patients with COPD have a greater risk of pneumonia versus reference controls; ICS use and concurrent asthma increased the risk of pneumonia further.

Keywords: Asthma; Chronic obstructive pulmonary disease; Comorbidities; Inhaled corticosteroids; Pneumonia; Sweden.

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Conflict of interest statement

Ethics approval and consent to participate

This study was conducted in accordance with the principles of the Declaration of Helsinki and ethical approval was granted by the ethics review board at Uppsala University, Sweden (number: 2014–397).

Consent for publication

Not applicable.

Competing interests

Christer Janson has received payments for educational activities from AstraZeneca, Boehringer Ingelheim, Chiesi, Novartis and Teva, and has served on advisory boards arranged by AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Novartis and Teva.

Gunnar Johansson has received payments for educational activities from AstraZeneca, Nycomed and Novartis and has served on advisory boards arranged by AstraZeneca, Novartis, Nycomed and Teva.

Björn Ställberg has received honoraria for educational activities and lectures from AstraZeneca, Boehringer Ingelheim, Meda, Novartis and Teva, and has served on advisory boards arranged by AstraZeneca, Novartis, Meda, GlaxoSmithKline, and Boehringer Ingelheim.

Karin Lisspers has received payments for educational activities and lectures from AstraZeneca, GlaxoSmithKline, Meda, MSD, Novartis and Nycomed and has served on advisory boards arranged by Novartis and Meda.

Kjell Larsson has, during the last five years, on one or more occasion served on an advisory board and/or served as speaker and/or participated in education arranged by AstraZeneca, Boehringer Ingelheim, Chiesi, Meda, Orion, Novartis, Teva and Takeda.

Milica Uhde and Leif Jorgensen are employees of IQVIA, who received remuneration in relation to statistical analysis.

Petter Olsson is an employee of Novartis Sverige AB.

Dorothy L Keininger and Florian S. Gutzwiller are employees of Novartis Pharma AG.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Study cohorts and criteria for patients with a doctor’s diagnosis of COPD and/or asthma. COPD chronic obstructive pulmonary disease; EMRs electronic medical records; ICS inhaled corticosteroids (low dose ICS: < 640 μg/day; high dose ICS: ≥800 μg/day)
Fig. 2
Fig. 2
Forest plot showing the HR for pneumonia in COPD and/or asthma patients versus reference population*. *(No COPD and/or asthma, no ICS). All results were statistically significant, p < 0.0001. HR above 1 is an increased risk of pneumonia. COPD chronic obstructive pulmonary disease; HR hazard ratio; ICS inhaled corticosteroids (low dose ICS: < 640 μg/day; high dose ICS: ≥800 μg/day)
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