Pneumonia risk in asthma patients using inhaled corticosteroids: a quasi‐cohort study

Qian, Christina; Coulombe, Janie; Suissa, Samy; Ernst, Pierre

doi:10.1111/bcp.13295

Cited by 49 publications

(59 citation statements)

References 38 publications

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“…15 Nevertheless, one Canadian cohort study of patients with asthma demonstrated that current ICS use was associated with a 45% relative increased risk of pneumonia, amounting to an excess of 1.44 cases per 1000 patient-years. 16 Interestingly, ciclesonide and mometasone, but not budesonide, beclomethasone, or fluticasone, exhibit in vitro suppression of SARS-CoV-2 replication to a similar degree as lopinavir, albeit in preliminary non peer reviewed data. 17 For ciclesonide, its target on viral replication appears to be nonstructural protein 15 (NSP15).…”

mentioning

confidence: 97%

Weathering the Cytokine Storm in Susceptible Patients with Severe SARS-CoV-2 Infection

Lipworth

Chan

Lipworth

et al. 2020

The Journal of Allergy and Clinical Immunology: In Practice

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mentioning

confidence: 97%

Weathering the Cytokine Storm in Susceptible Patients with Severe SARS-CoV-2 Infection

Lipworth

Chan

Lipworth

et al. 2020

The Journal of Allergy and Clinical Immunology: In Practice

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“…In fact, the proportion of patients with pneumonia at the index hospitalisation was around 80%. The higher incidence of COPD exacerbation in the control group may therefore be explained by the fact that ICS increases the risk of lower respiratory tract infection, including pneumonia, in patients with COPD [7,8], as well as in those with bronchial asthma [9,10]. Notably, the mean age of our study population was around 78 years.…”

Section: Discussionmentioning

confidence: 84%

“…Adverse effects including candidiasis, cataract, glaucoma, diabetes, bone fracture, and pneumonia have been associated with high-dose ICSs [6] and have been raised as an issue, particularly in elderly patients [7,8]. In addition, an increased risk of lower respiratory tract infection associated with the use of ICSs has also been reported in patients with bronchial asthma [9,10].…”

Section: Introductionmentioning

confidence: 99%

Inhaled corticosteroid withdrawal may improve outcomes in elderly patients with COPD exacerbation: a nationwide database study

Yasunaga

Yamauchi

et al. 2020

ERJ Open Res

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BackgroundInhaled corticosteroids (ICSs) are used for advanced-stage chronic obstructive pulmonary disease (COPD). The application and safety of ICS withdrawal remain controversial.This study aimed to evaluate the association between ICS withdrawal and outcomes in elderly patients with COPD with or without comorbid bronchial asthma, who were hospitalised for exacerbation.Patients and methodsWe conducted a retrospective cohort study using the Japanese Diagnosis Procedure Combination database from July 2010 to March 2016. We identified patients aged ≥65 years who were hospitalised for COPD exacerbation. Re-hospitalisation for COPD exacerbation or death, frequency of antimicrobial medicine prescriptions and frequency of oral corticosteroid prescriptions after discharge were compared between patients with withdrawal and continuation of ICSs using propensity score analyses, namely 1–2 propensity score matching and stabilised inverse probability of treatment weighting.ResultsAmong 3735 eligible patients, 971 and 2764 patients had ICS withdrawal and continuation, respectively. The hazard ratios (95% confidence intervals) of re-hospitalisation for COPD exacerbation or death for ICS withdrawal compared to continuation were 0.65 (0.52–0.80) in the propensity score matching and 0.71 (0.56–0.90) in the inverse probability of treatment weighting. The frequency of antimicrobial prescriptions but not corticosteroid prescriptions within 1 year was significantly less in the ICS withdrawal group. Among patients with comorbid bronchial asthma, ICS withdrawal was significantly associated with reduced re-hospitalisation for COPD exacerbation or death only in the propensity score matching analysis.ConclusionICS withdrawal after COPD exacerbation was significantly associated with reduced incidences of re-hospitalisation or death among elderly patients, including those with comorbid bronchial asthma.

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“…A more recent study, by using a quasi-cohort design, concluded that subjects with asthma were at greater risk for pneumonia if they used ICS therapy. 39 The overall risk associated with current ICS use was 1.83. The relative risk was dose related (1.6 for low dose and 1.96 for high dose), and higher for budesonide and fluticasone compared with other agents (2.67 and 1.93, respectively).…”

Section: Adverse Drug Reactions and Side Effectsmentioning

confidence: 98%

Clinical Pharmacology of Corticosteroids

2018

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Corticosteroids have numerous applications in treating inflammation and diseases of immune function based on their significant anti-inflammatory and immunosuppressive effects. Corticosteroids modulate immune function through various effects in the nucleus of numerous cells. When used in pharmacologic doses to suppress allergic responses or inflammation, these agents can cause numerous adverse effects associated with an excess of glucocorticoid activity. Prolonged use (>2 wk) results in suppression of the hypothalamic-pituitary-adrenal axis, which requires tapering of doses. Dosing strategies for systemic corticosteroids are designed to minimize the risk for hypothalamic-pituitary-adrenal axis suppression. Topical administration of corticosteroids, including oral inhalation, is often used to avoid the significant adverse effects associated with chronic use. Inhaled corticosteroids are potent synthetic agents that exert their actions locally in the airways but can cause systemic effects based on several factors that influence systemic bioavailability. Inhaled corticosteroids are the cornerstone of asthma therapy and important options for COPD in patients who experience frequent exacerbations. By the nasal route, they are the most effective therapy for treating moderate-to-severe allergic rhinitis.

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Pneumonia risk in asthma patients using inhaled corticosteroids: a quasi‐cohort study

Abstract: ICS use in asthma patients appears to be associated with an increased risk of pneumonia and is present for both budesonide and fluticasone.

Cited by 49 publications

References 38 publications

Weathering the Cytokine Storm in Susceptible Patients with Severe SARS-CoV-2 Infection

Weathering the Cytokine Storm in Susceptible Patients with Severe SARS-CoV-2 Infection

Inhaled corticosteroid withdrawal may improve outcomes in elderly patients with COPD exacerbation: a nationwide database study

Clinical Pharmacology of Corticosteroids

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