COPD Exacerbation-Related Pathogens and Previous COPD Treatment

Abstract

We evaluated whether the pathogens identified during acute exacerbation of chronic obstructive pulmonary disease (AE-COPD) are associated with the COPD medications used in the 6 months before AE-COPD. We collected the medical records of patients diagnosed with AE-COPD at 28 hospitals between January 2008 and December 2019 and retrospectively analyzed them. Microorganisms identified at the time of AE-COPD were analyzed according to the use of inhaled corticosteroid (ICS) and systemic steroid after adjusting for COPD severity. We evaluated 1177 patients with AE-COPD and available medication history. The mean age of the patients was 73.9 ± 9.2 years, and 83% were males. The most frequently identified bacteria during AE-COPD were Pseudomonas aeruginosa (10%), followed by Mycoplasma pneumoniae (9.4%), and Streptococcus pneumoniae (5.1%), whereas the most commonly identified viruses were rhinovirus (11%) and influenza A (11%). During AE-COPD, bacteria were more frequently identified in the ICS than non-ICS group (p = 0.009), and in the systemic steroid than non-systemic steroid group (p < 0.001). In patients who used systemic steroids before AE-COPD, the risk of detecting Pseudomonas aeruginosa was significantly higher during AE-COPD (OR 1.619, CI 1.007–2.603, p = 0.047), but ICS use did not increase the risk of Pseudomonas detection. The risk of respiratory syncytial virus (RSV) detection was low when ICS was used (OR 0.492, CI 0.244–0.988, p = 0.045). COPD patients who used ICS had a lower rate of RSV infection and similar rate of P. aeruginosa infection during AE-COPD compared to patients who did not use ICS. However, COPD patients who used systemic steroids within 6 months before AE-COPD had an increased risk of P. aeruginosa infection. Therefore, anti-pseudomonal antibiotics should be considered in patients with AE-COPD who have used systemic steroids.

Comparison of Infection Risks Between Various Inhaled and Intranasal Corticosteroids: A Pharmacovigilance Analysis Based on the FAERS Database

“…A retrospective study evaluated whether pathogens discovered during acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in 28 hospitals between 2008 and 2019 were associated with ICS used within the 6 months before AECOPD. 16 The results indicated that pathogenic specimens of AECOPD patients using ICS or ICS/LABA were more likely to isolate M. Pneumonia , especially those with frequent social activities and frequent travel to crowded areas, but were less likely to isolate Pseudomonas aeruginosa. A case-control study from 2012 to 2020 showed that the risk of P. aeruginosa infection in severe COPD patients was not related to the use of inhaled Fluticasone, but to the dosage of Fluticasone, and high doses of Fluticasone increased the risk of P. aeruginosa infection.…”

“… 18 Meanwhile, studies have shown that compared to the respiratory respiratory syncytial virus (RSV) and coronavirus, rhinovirus and influenza A virus were the most detected viruses in AECOPD patients who previously used ICS. 16 Studies showed that long-term use of ICS did not increase the risk of SARS-COV2 infection. 19 , 20 Multiple meta-analyses have shown that ICS could increase the risk of tuberculosis (TB) and non-tuberculosis mycobacterial (NTM) infections, and the higher the dosage of ICS, the more significant the risk.…”

Inhaled corticosteroids and risk of lower respiratory tract infection withMoraxella catarrhalisin patients with chronic obstructive pulmonary disease

“…Long-term use of ICS in patients with COPD has been shown to affect the lung microbiome, and although much is yet to be learnt, current data suggest that ICS use may increase bacterial load and may promote the persistence of certain bacterial pathogens including H. influenzae 10 26 . M. catarrhalis has previously been described to often participate as a copathogen in respiratory tract infections with other bacteria including H. influenzae and P. aeruginosa 13.…”

Respiratory Syncytial Virus Infection in Older Adults: An Update

“…A multicentre study was conducted in 28 hospitals between January 2015 and December 2018 in the Republic of South Korea in a cohort of 1177 patients hospitalized with a diagnosis of acute exacerbation of COPD. The most commonly detected viruses were rhinovirus (11%) and influenza virus A (11%), followed by RSV (4.3%) [ 43 ].…”