Influence of Previous Use of Inhaled Corticoids on the Development of Pleural Effusion in Community-acquired Pneumonia

Sellarés, Jacobo; López-Giraldo, Alejandra; Lucena, Carmen; Cillóniz, Catia; Amaro, Rosanel; Polverino, Eva; Ferrer, Miquel; Menéndez, Rosário; Mensa, Josep; Torres, Antoni

doi:10.1164/rccm.201209-1732oc

Cited by 52 publications

(51 citation statements)

References 39 publications

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“…Although the use of inhaled corticosteroids in COPD patients has been demonstrated to be useful in the reduction of exacerbation events 16,17 and in protection against the development of complicated forms of hospitalized community-acquired pneumonia. 14,15 On the other hand, the long-term use of inhaled corticosteroids increases the risk of pneumonia, [18][19][20] especially with fluticasone. 20 Our study, performed in subjects with COPD exacerbation but without pneumonia, demonstrates that inhaled corticosteroids have no detrimental effect on the development of complications on admission or in other outcomes collected during the clinical course.…”

Section: Discussionmentioning

confidence: 99%

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Inhaled Corticosteroids Do Not Influence the Early Inflammatory Response and Clinical Presentation of Hospitalized Subjects With COPD Exacerbation

et al. 2014

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BACKGROUND: Inhaled corticosteroids are anti-inflammatory medications that can down-regulate the immunologic response in patients with COPD; however, their role at onset of COPD exacerbation is still not understood. The aim of this study was to assess the early inflammatory response and clinical presentation of patients with COPD exacerbation mediated by inhaled corticosteroids. METHODS: Prospective data were collected on 123 hospitalized subjects with COPD exacerbation over a 30-month period at 2 Spanish university hospitals. Based on domiciliary use, comparative analyses were performed between subjects who did not use inhaled corticosteroids (n ‫؍‬ 58) and subjects who did (n ‫؍‬ 65). Measurements of serum biomarkers were recorded on admission to the hospital (day 1) and on day 3; clinical, physiological, microbiological, and severity data and mortality/readmission rates were also recorded. RESULTS: At days 1 and 3, both groups showed a similar inflammatory response; fluticasone produced lower levels of interleukin-8 compared with budesonide (P < .01). All clinical features considered were similar in the 2 groups; multivariate analysis predicting clinical complications on hospitalization showed air-flow obstruction severity as the only predictive factor (odds ratio 3.13, 95% CI 1.13-8.63, P ‫؍‬ .02). CONCLUSIONS: Our study demonstrates a lack of inhaled corticosteroid influence in the early systemic inflammatory response to and clinical presentation of COPD exacerbation.

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Section: Discussionmentioning

confidence: 99%

“…13 In hospitalized COPD patients with community-acquired pneumonia, inhaled corticosteroids protect against more severe forms 14 and against complicated pleural effusion. 15 These beneficial effects in community-acquired pneumonia may be explained by down-regulation of the inflammatory response.…”

Section: Introductionmentioning

confidence: 99%

Inhaled Corticosteroids Do Not Influence the Early Inflammatory Response and Clinical Presentation of Hospitalized Subjects With COPD Exacerbation

et al. 2014

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“…Some of these studies also reported an improvement in other pertinent outcomes among patients using ICS, such as decreased risk of parapneumonic effusion and less frequent need for mechanical ventilation and vasopressors (10,11,14). Pneumonia ascertainment was better and more systematic in these observational studies than in the RCTs analyzed in a previous systematic review (15).…”

mentioning

confidence: 84%

“…The short-term mortality after hospitalization for pneumonia was again decreased (relative risk, 0.75 [95% CI, 0.69-0.82]). Four other studies, encompassing only one-fourth of patients, demonstrated no increased risk of pneumonia-related death with the wide CIs (8,13,14,30). Retrospective, observational design adds to the above-mentioned imprecision of assessment of pneumoniarelated mortality.…”

Section: Pneumonia-related Mortalitymentioning

confidence: 95%

Incident Pneumonia and Mortality in Patients with Chronic Obstructive Pulmonary Disease. A Double Effect of Inhaled Corticosteroids?

Festić

Scanlon

2015

Am J Respir Crit Care Med

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Inhaled corticosteroids are commonly prescribed for patients with severe chronic obstructive pulmonary disease. Although their use improves quality of life and reduces exacerbations, it is associated with increased risk of pneumonia. Curiously, their use has not been associated with increased risk of pneumonia-related or overall mortality. We review pertinent literature to further explore the effects of inhaled corticosteroids on incident pneumonia and mortality in patients with chronic obstructive pulmonary disease. The association of use of inhaled corticosteroids and incident pneumonia is substantial and has been present in the majority of the studies on the topic. This includes both randomized controlled trials and observational studies. However, all of the studies have substantial risk of bias. Most randomized trials are limited by lack of systematic ascertainment of pneumonia; they depended on adverse event reporting. Many observational studies included proper radiographic assessment of pneumonia, but they are limited by their retrospective, observational design. The unadjusted higher risk of pneumonia is associated with longer duration of use, more potent ICS compounds, and higher doses. That implies a dose-effect relationship. Unlike pneumonia, mortality is a precise outcome. Despite the robust association of inhaled corticosteroid use with increased risk of pneumonia, all studies find either no difference or a reduction in pulmonary-related and overall mortality associated with the use of inhaled corticosteroids. These observations suggest a double effect of inhaled corticosteroids (i.e., an adverse effect plus an unexplained mitigating effect).

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“…Меншу частоту ускладнення НП ексудативним плевритом у хворих з астмою (3,4% проти 5,2%, p<0,001) та хронічним об-структивним захворюванням легень (3,4% проти 5,2%, p<0,001) описували F. [10]. Існують відомості про протективний вплив регулярного прийому інгаляційних кортикосте-роїдів на розвиток цього ускладення НП [3].…”

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Chronic comorbidity of internal organs as a risk factor of complications and fatal outcome of community-acquired pneumonia.

Mostovoy¹,

Demchuk²,

Konstantynovych³

et al. 2018

Medicni Perspektivi (Medical Perspectives)

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Influence of Previous Use of Inhaled Corticoids on the Development of Pleural Effusion in Community-acquired Pneumonia

Abstract: Prior treatment with ICS in a population of patients with different respiratory chronic disorders who develop pneumonia is associated with lower incidence of parapneumonic effusion.

Cited by 52 publications

References 39 publications

Inhaled Corticosteroids Do Not Influence the Early Inflammatory Response and Clinical Presentation of Hospitalized Subjects With COPD Exacerbation

Inhaled Corticosteroids Do Not Influence the Early Inflammatory Response and Clinical Presentation of Hospitalized Subjects With COPD Exacerbation

Incident Pneumonia and Mortality in Patients with Chronic Obstructive Pulmonary Disease. A Double Effect of Inhaled Corticosteroids?

Chronic comorbidity of internal organs as a risk factor of complications and fatal outcome of community-acquired pneumonia.

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