Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 May 20;13(1):8183.
doi: 10.1038/s41598-023-35223-3.

Comparison of pneumonia incidence between long-acting muscarinic antagonist and inhaled corticosteroid plus long-acting beta agonist in patients with COPD

Eung Gu Lee  1 , Youlim Kim  2 , Yong Il Hwang  3 , Kwang Ha Yoo  2 , So Eun Lee  4 , Kyung Yoon Jung  4 , Doik Lee  5 , Yong Bum Park  6 , Chin Kook Rhee  7
Affiliations

Comparison of pneumonia incidence between long-acting muscarinic antagonist and inhaled corticosteroid plus long-acting beta agonist in patients with COPD

Eung Gu Lee et al. Sci Rep. .

Abstract

Few studies have directly compared the incidence of pneumonia in patients on common chronic obstructive pulmonary disease (COPD) treatments such as long-acting muscarinic antagonists (LAMA) with those on inhaled corticosteroids and long-acting β2-agonist (ICS/LABA). Moreover, risk factors for pneumonia in COPD are still unclear. We aimed to compare the incidence of pneumonia in COPD patients on LAMA and those on ICS/LABA and explored the risk factors associated with pneumonia. This nationwide cohort study used Korean National Health Insurance claim data from January 2002 to April 2016. Patients who received COPD medication, either LAMA or ICS/LABA, with the COPD diagnostic code, were selected. We enrolled patients with good compliance (medication possession ratio ≥ 80%). The primary outcome was pneumonia in COPD patients initiating LAMA or ICS/LABA. We investigated the risk factors associated with pneumonia, including the sub-types of ICS treatments. After propensity score matching, the incidence rate per 1000 person-years of pneumonia was 93.96 for LAMA (n = 1003) and 136.42 for ICS/LABA (n = 1003) patients (p < 0.001). The adjusted hazard ratio (HR) for pneumonia in patients on fluticasone/LABA was 1.496 (95% confidence interval [CI] 1.204-1.859) compared with LAMA (p < 0.001). In multivariable analysis, a history of pneumonia was a risk factor associated with pneumonia (HR 2.123; 95% CI 1.580-2.852; p < 0.001). The incidence of pneumonia was higher in COPD patients on ICS/LABA compared with those on LAMA. It is recommended that ICS use be avoided in COPD patients with high pneumonia risk.

PubMed Disclaimer

Conflict of interest statement

EGL and YIH have no conflict of interest. CKR received consulting and lecture fees from MSD, AstraZeneca, GlaxoSmithKline, Novartis, Takeda, Mundipharma, Boehringer-Ingelheim, TEVA, Sanofi, and Bayer. KHY has conducted clinical trials in Asthma, COPD, and Pneumonia with GlaxoSmithKline, AstraZeneca, Boehringer-Ingelheim, Novartis, Takeda, Nycomed, TEVA, MSD, Mundipharma, Hyundai Ankook, Chongkendang, Hanmi, and Hanlym. He received consulting fees from GlaxoSmithKline, AstraZeneca, Boehringer-Ingelheim, Novartis, Mundipharma, Ankook, Chongkendang, Hanmi, and Hanlym. YBP received consulting and lecture fees from AstraZeneca, GlaxoSmithKline, Novartis, Mundipharma, Boehringer-Ingelheim, and Sanofi. SEL was a former employee of Boehringer-Ingelheim Korea. KYJ was a former employee of Boehringer-Ingelheim Korea. YK received consulting and lecture fees from MSD, GlaxoSmithKline, Boehringer-Ingelheim, and Hanlim.

Figures

Figure 1
Figure 1
Overview of the study design.
Figure 2
Figure 2
Flow chart of patient selection.
Figure 3
Figure 3
(A) Time to first pneumonia event in patients on ICS/LABA vs. LAMA. (B) Time to first pneumonia-related hospitalization event in patients on ICS/LABA vs. LAMA. (C) Time to first outpatient pneumonia event in patients on ICS/LABA vs. LAMA. (D) Time to pneumonia-related death in patients on ICS/LABA vs. LAMA. ICS inhaled corticosteroids, LABA long acting β2-agonists, LAMA long-acting muscarinic antagonists.
Figure 3
Figure 3
(A) Time to first pneumonia event in patients on ICS/LABA vs. LAMA. (B) Time to first pneumonia-related hospitalization event in patients on ICS/LABA vs. LAMA. (C) Time to first outpatient pneumonia event in patients on ICS/LABA vs. LAMA. (D) Time to pneumonia-related death in patients on ICS/LABA vs. LAMA. ICS inhaled corticosteroids, LABA long acting β2-agonists, LAMA long-acting muscarinic antagonists.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Vogelmeier CF, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive lung disease 2017 report. GOLD executive summary. Am. J. Respir. Crit. Care Med. 2017;195:557–582. doi: 10.1164/rccm.201701-0218PP. - DOI - PubMed
    1. Lozano R, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: A systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380:2095–2128. doi: 10.1016/s0140-6736(12)61728-0. - DOI - PMC - PubMed
    1. Mannino DM, Buist AS. Global burden of COPD: Risk factors, prevalence, and future trends. Lancet. 2007;370:765–773. doi: 10.1016/s0140-6736(07)61380-4. - DOI - PubMed
    1. Anzueto A, Miravitlles M. The role of fixed-dose dual bronchodilator therapy in treating COPD. Am. J. Med. 2018;131:608–622. doi: 10.1016/j.amjmed.2017.12.018. - DOI - PubMed
    1. Vedel-Krogh S, Nielsen FS, Lange P, Vestbo J, Nordestgaard BG. Blood eosinophils and exacerbations in chronic obstructive pulmonary disease: The Copenhagen general population study. Am. J. Respir. Crit. Care Med. 2016;193:965–974. doi: 10.1164/rccm.201509-1869OC. - DOI - PubMed

Publication types

MeSH terms

Substances