Severe exacerbation and pneumonia in COPD patients treated with fixed combinations of inhaled corticosteroid and long-acting beta2 agonist

Yang, Hsi-Hsing; Lai, Chih‐Cheng; Wang, Yahui; Yang, Wei-Chih; Chen, Ming-Fong; Wang, Hao-Chien; Chen, Likwang; Yu, Chong‐Jen

doi:10.2147/copd.s139035

Cited by 19 publications

(23 citation statements)

References 24 publications

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“…This could be related to the low proportion of patients using fluticasone propionate, since previous data suggests its use is associated with a particular increase in the risk of pneumonia. For example, a population-based cohort study showed that patients receiving fluticasone had a higher incidence rate and a higher risk of pneumonia than patients receiving budesonide (12.11 per 100 person-years vs. 10.65 per 100 person-years, adjusted HR 1.13, 95% CI: 1.08–1.20) [ 27 ]. An observational study also showed that the rate of serious pneumonia was doubled with fluticasone propionate (rate ratio [RR] 2.01; 95% CI: 1.93–2.10) and increased with the daily dose.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2018

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BackgroundInhaled 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.MethodsElectronic 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.ResultsA 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).ConclusionsPatients with COPD have a greater risk of pneumonia versus reference controls; ICS use and concurrent asthma increased the risk of pneumonia further.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2018

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“…This study used a subset of the NHIRD comprising information on individuals with COPD. 5 , 7 There were 62,505 eligible COPD patients who were aged older than 40 years between 2000 and 2005. We excluded 40,026 patients who did not meet the following criteria: 1) patients without prescription of ACEi or ARB before COPD index date; 2) patients who received ACEi or ARB <90 days after COPD index date; 3) patients with ACEi and ARB combined treatment; and 4) patients who died or were diagnosed with pneumonia or severe pneumonia prior to being indexed ( Figure 1 ).…”

Section: Methodsmentioning

confidence: 99%

“…The patients with pneumonia were identified according to the International Classification of Diseases, Ninth Revision, Clinical Modification codes as previously described. 5 , 17 For patients with more than one episode of pneumonia, only the first episode was included. A severe exacerbation was defined as a COPD-related hospitalization or emergency department visit.…”

Section: Methodsmentioning

confidence: 99%

“…In addition, patients with COPD are at a higher risk of pulmonary infection than the general population. 3 , 4 Moreover, many studies 5 – 7 have shown that inhaled and systemic corticosteroid therapy, which is frequently used to control COPD and manage COPD exacerbations, can further increase the risk of pneumonia. Therefore, preventing pneumonia in patients with COPD has become an important issue.…”

Section: Introductionmentioning

confidence: 99%

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Comparative effects of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers on the risk of pneumonia and severe exacerbations in patients with COPD

Lai

Wang

Chen

et al. 2018

COPD

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ObjectivesThis study aimed to compare the effects of angiotensin-converting-enzyme inhibitors (ACEis) and angiotensin receptor blockers (ARBs) on the risk of pneumonia and severe exacerbations in patients with COPD.Patients and methodsAll patients with COPD who used ACEis and ARBs for >90 days between 2000 and 2005 were recruited. Pairwise matching (1:1) of the ACEi and ARB groups resulted in two similar subgroups, with 6,226 patients in each. The primary outcomes were pneumonia and COPD exacerbations, and the secondary outcome was death.ResultsDuring the follow-up period, the incidence of pneumonia was 7.20 per 100 person-years in the ACEi group and 5.89 per 100 person-years in the ARB group. The ACEi group had a higher risk of pneumonia (adjusted hazard ratio [aHR], 1.22; 95% CI, 1.15–1.29) than the ARB group. The incidence of severe exacerbations was 0.65 per person-year for the patients receiving ACEis and 0.52 per person-year for those receiving ARBs. The patients receiving ACEis had a higher risk of severe exacerbations (aHR, 1.19; 95% CI, 1.16–1.21) than those receiving ARBs. Similar trends were noted in terms of severe exacerbations requiring hospitalization (aHR, 1.24; 95% CI, 1.21–1.28) or emergency department visits (aHR, 1.16; 95% CI, 1.13–1.18), pneumonia requiring mechanical ventilation (aHR, 1.35; 95% CI, 1.24–1.47), and mortality (aHR, 1.33; 95% CI, 1.26–1.42).ConclusionARBs were associated with lower rates of pneumonia, severe pneumonia, and mortality than ACEis in patients with COPD.

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“…To identify patients with COPD, all NHI enrollees who were 40 years or older and had a diagnosis of COPD (ICD-9-CM codes 491, 492, and 496) in at least two outpatient (OPD) visits or one hospitalization were screened. 12 , 13 The index date was defined as the date of first medical visit with the ICD-9 CM code for COPD. Those screened patients who had received short-acting muscarinic antagonist (SAMA), long-acting muscarinic antagonist (LAMA), short-acting β2-agonist (SABA), long-acting β2-agonist (LABA), inhaled corticosteroid (ICS), fixed-dose combination of LABA and ICS, or xanthines after the index date were enrolled in this study.…”

Section: Methodsmentioning

confidence: 99%

Trends in health care resource utilization and pharmacological management of COPD in Taiwan from 2004 to 2010

Tsai

Yang

Lin

et al. 2017

COPD

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RationaleCOPD has attracted widespread attention worldwide. The prevalence of COPD in Taiwan has been reported, but little is known about trends in health care resource utilization and pharmacologic management in COPD treatment.ObjectiveThe objective of this article was to study trends in health care resource utilization, pharmacologic management, and medical costs of COPD treatment in Taiwan.Materials and methodsReimbursement claims in the Taiwan National Health Insurance System from 2004 to 2010 were collected. The disease burden of COPD, including health care resource utilization and medical costs, was evaluated.ResultsThe pharmacy cost of COPD increased from 2004 to 2010 due to the increased utilization of long-acting muscarinic antagonist (LAMA) and fixed-dose combination of long-acting β2-agonist and inhaled corticosteroid (LABA/ICS), whereas the cost of all other COPD-related medications decreased. The average outpatient department (OPD) cost per patient increased 29.3% from 1,070 USD in 2004 to 1,383 USD in 2010. The highest average total medical cost per patient was 3,434 USD in 2005, and it decreased 12.4% to 3,008 USD in 2010. There was no significant difference in the average number of OPD visits and emergency department visits per patient. The highest average number of hospital admissions was 0.81 in 2005, and it decreased to 0.65 in 2010. The average number of intensive care unit (ICU) admissions decreased from 0.52 in 2005 to 0.31 in 2010.ConclusionFrom 2004 to 2010, the average total medical cost per patient of COPD was slightly decreased because of the decreased average number of hospital admissions and ICU admissions. The costs of both LAMA and LABA/ICS increased, while the cost for all other COPD-related medications decreased. These findings suggest that the increased utilization of LAMA and LABA/ICS may have contributed to the decreased average number of hospital admissions and ICU admissions in COPD patients from 2004 to 2010.

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Severe exacerbation and pneumonia in COPD patients treated with fixed combinations of inhaled corticosteroid and long-acting beta2 agonist

Cited by 19 publications

References 24 publications

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

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

Comparative effects of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers on the risk of pneumonia and severe exacerbations in patients with COPD

Trends in health care resource utilization and pharmacological management of COPD in Taiwan from 2004 to 2010

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