Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

ACC 2024 Congress

Catch up on all the top stories and latest evidence in cardiology research with our ACC 2024 Congress hub page.
ADVANCED SEARCH
Log in
Top
Respiratory Research
Published in: Respiratory Research 1/2018

Open Access 01-12-2018 | Research

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

Authors: Christer Janson, Gunnar Johansson, Björn Ställberg, Karin Lisspers, Petter Olsson, Dorothy L. Keininger, Milica Uhde, Florian S. Gutzwiller, Leif Jörgensen, Kjell Larsson

Published in: Respiratory Research | Issue 1/2018

Login to get access

Abstract

Background

Inhaled 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.

Methods

Electronic 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.

Results

A 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).

Conclusions

Patients with COPD have a greater risk of pneumonia versus reference controls; ICS use and concurrent asthma increased the risk of pneumonia further.
Literature
1.
2.
Price D, Jones R, Gruffyd-Jones K, Brusselle G, Miravitlles M, Baldwin M, et al. Real-world prescribing patterns among newly diagnosed COPD patients receiving ICS: an analysis of UK patient dataset. Eur Respir J 2014;44(Suppl. 58):P2422 (Abstract).
3.
White P, Thornton H, Pinnock H, Georgopoulou S, Booth HP. Overtreatment of COPD with inhaled corticosteroids--implications for safety and costs: cross-sectional observational study. PLoS One. 2013;8:e75221.CrossRefPubMedPubMedCentral
4.
Miravitlles M, Sicras A, Crespo C, Cuesta M, Brosa M, Galera J, et al. Costs of chronic obstructive pulmonary disease in relation to compliance with guidelines: a study in the primary care setting. Ther Adv Respir Dis. 2013;7:139–50.CrossRefPubMed
5.
Läkemedelverkets Medical Products Agency (Sweden): Läkemedelverkets expert panel. Farmakologisk behandling av kroniskt obstruktiv lungsjukdom (KOL) – behandlingsrekommendationer (In Swedish). 2009:Suppl 2:13–28. Available at: https://​lakemedelsverket​.​se/​kol.
6.
7.
Calverley PM, Anderson JA, Celli B, Ferguson GT, Jenkins C, Jones PW, et al. Salmeterol and fluticasone propionate and survival in chronic obstructive pulmonary disease. N Engl J Med. 2007;356:775–89.CrossRefPubMed
8.
Ferguson GT, Anzueto A, Fei R, Emmett A, Knobil K, Kalberg C. Effect of fluticasone propionate/salmeterol (250/50 mg) or salmeterol (50 mg) on COPD exacerbations. Respir Med. 2008;102:1099–108.CrossRefPubMed
9.
Anzueto A, Ferguson GT, Feldman G, Chinsky K, Seibert A, Emmett A, et al. Effect of fluticasone propionate/salmeterol (250/50) on COPD exacerbations and impact on patient outcomes. COPD. 2009;6:320–9.CrossRefPubMed
10.
Calverley PM, Stockley RA, Seemungal TA, Hagan G, Willits LR, Riley JH, et al. Reported pneumonia in patients with COPD: findings from the INSPIRE study. Chest. 2011;139:505–12.CrossRefPubMed
11.
Sharafkhaneh A, Southard JG, Goldman M, Uryniak T, Martin UJ. Effect of budesonide/formoterol pMDI on COPD exacerbations: a double-blind, randomized study. Respir Med. 2012;106:257–68.CrossRefPubMed
12.
Dransfield MT, Bourbeau J, Jones PW, Hanania NA, Mahler DA, Vestbo J, et al. Once-daily inhaled fluticasone furoate and vilanterol versus vilanterol only for prevention of exacerbations of COPD: two replicate double-blind, parallel-group, randomised controlled trials. Lancet Respir Med. 2013;1:210–23.CrossRefPubMed
13.
Singh S, Amin AV, Loke YK. Long-term use of inhaled corticosteroids and the risk of pneumonia in chronic obstructive pulmonary disease: a meta-analysis. Arch Intern Med. 2009;169:219–29.CrossRefPubMed
14.
Festic E, Bansal V, Gupta E, Scanlon PD. Association of inhaled corticosteroids with incident pneumonia and mortality in COPD patients; systematic review and meta-analysis. COPD. 2015;13:312–26.CrossRefPubMedPubMedCentral
15.
Janson C, Larsson K, Lisspers KH, Stallberg B, Stratelis G, Goike H, et al. Pneumonia and pneumonia related mortality in patients with COPD treated with fixed combinations of inhaled corticosteroid and long acting b2 agonist: observational matched cohort study (PATHOS). BMJ. 2013;346:f3306.CrossRefPubMedPubMedCentral
16.
17.
18.
Hardin M, Cho M, McDonald ML, Beaty T, Ramsdell J, Bhatt S, et al. The clinical and genetic features of COPD-asthma overlap syndrome. Eur Respir J. 2014;44:341–50.CrossRefPubMedPubMedCentral
19.
de Marco R, Marcon A, Rossi A, Anto JM, Cerveri I, Gislason T, et al. Asthma, COPD and overlap syndrome: a longitudinal study in young European adults. Eur Respir J. 2015;46:671–9.CrossRefPubMed
20.
21.
22.
23.
Wedzicha JA, Calverley PM, Seemungal TA, Hagan G, Ansari Z, Stockley RA, et al. The prevention of chronic obstructive pulmonary disease exacerbations by salmeterol/fluticasone propionate or tiotropium bromide. Am J Respir Crit Care Med. 2008;177:19–26.CrossRefPubMed
24.
Crim C, Calverley PM, Anderson JA, Celli B, Ferguson GT, Jenkins C, et al. Pneumonia risk in COPD patients receiving inhaled corticosteroids alone or in combination: TORCH study results. Eur Respir J. 2009;34:641–7.CrossRefPubMed
25.
Welte T, Miravitlles M, Hernandez P, Eriksson G, Peterson S, Polanowski T, et al. Efficacy and tolerability of budesonide/formoterol added to tiotropium in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2009;180:741–50.CrossRefPubMed
26.
Rennard SI, Tashkin DP, McElhattan J, Goldman M, Ramachandran S, Martin UJ, et al. Efficacy and tolerability of budesonide/formoterol in one hydrofluoroalkane pressurized metered-dose inhaler in patients with chronic obstructive pulmonary disease: results from a 1-year randomized controlled clinical trial. Drugs. 2009;69:549–65.CrossRefPubMedPubMedCentral
27.
Yang HH, Lai CC, Wang YH, Yang WC, Wang CY, Wang HC, et al. Severe exacerbation and pneumonia in COPD patients treated with fixed combinations of inhaled corticosteroid and long-acting beta2 agonist. Int J Chron Obstruct Pulmon Dis. 2017;12:2477–85.CrossRefPubMedPubMedCentral
28.
29.
Jenkins CR, Jones PW, Calverley PM, Celli B, Anderson JA, Ferguson GT, et al. Efficacy of salmeterol/fluticasone propionate by GOLD stage of chronic obstructive pulmonary disease: analysis from the randomised, placebo-controlled TORCH study. Respir Res. 2009;10:59.CrossRefPubMedPubMedCentral
30.
Teepe J, Grigoryan L, Verheij TJ. Determinants of community-acquired pneumonia in children and young adults in primary care. Eur Respir J. 2010;35:1113–7.CrossRefPubMed
31.
Soriano JB, Visick GT, Muellerova H, Payvandi N, Hansell AL. Patterns of comorbidities in newly diagnosed COPD and asthma in primary care. Chest. 2005;128:2099–107.CrossRefPubMed
32.
Mannino DM, Thorn D, Swensen A, Holguin F. Prevalence and outcomes of diabetes, hypertension and cardiovascular disease in COPD. Eur Respir J. 2008;32:962–9.CrossRefPubMed
33.
Stallberg B, Janson C, Johansson G, Larsson K, Stratelis G, Telg G, et al. Management, morbidity and mortality of COPD during an 11-year period: an observational retrospective epidemiological register study in Sweden (PATHOS). Prim Care Respir J. 2014;23:38–45.CrossRefPubMed
34.
Sundh J, Janson C, Lisspers K, Montgomery S, Stallberg B. Clinical COPD questionnaire score (CCQ) and mortality. Int J Chron Obstruct Pulmon Dis. 2012;7:833–42.CrossRefPubMedPubMedCentral
35.
Joo MJ, Au DH, Fitzgibbon ML, Lee TA. Inhaled corticosteroids and risk of pneumonia in newly diagnosed COPD. Respir Med. 2010;104:246–52.CrossRefPubMed
36.
Global Initiative for Chronic Obstructive Lung Disease (GOLD): Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. 2018 Report. Available at: http://​goldcopd.​org/​gold-reports/​. Last accessed 28 November 2017.
37.
Melbye H, Straume B, Aasebo U, Brox J. The diagnosis of adult pneumonia in general practice. The diagnostic value of history, physical examination and some blood tests. Scand J Prim Health Care. 1988;6:111–7.CrossRefPubMed
38.
Atsou K, Chouaid C, Hejblum G. Variability of the chronic obstructive pulmonary disease key epidemiological data in Europe: systematic review. BMC Med. 2011;9:7.CrossRefPubMedPubMedCentral
39.
Vogelmeier CF, Bateman ED, Pallante J, Alagappan VK, D'Andrea P, Chen H, et al. Efficacy and safety of once-daily QVA149 compared with twice-daily salmeterol-fluticasone in patients with chronic obstructive pulmonary disease (ILLUMINATE): a randomised, double-blind, parallel group study. Lancet Respir Med. 2013;(1):51–60.
40.
Zhong N, Wang C, Zhou X, Zhang N, Humphries M, Wang C, et al. LANTERN: a randomized study of QVA149 versus salmeterol/fluticasone combination in patients with COPD. Int J Chron Obstruct Pulmon Dis. 2015;10:1015–26.PubMedPubMedCentral
41.
Wedzicha JA, Banerji D, Chapman KR, Vestbo J, Roche N, Ayers RT, et al. Indacaterol-glycopyrronium versus salmeterol-fluticasone for COPD. N Engl J Med. 2016;374:2222–34.CrossRefPubMed
Metadata
Title
 Identifying the associated risks of pneumonia in COPD patients: ARCTIC an observational study
Authors
Christer Janson
Gunnar Johansson
Björn Ställberg
Karin Lisspers
Petter Olsson
Dorothy L. Keininger
Milica Uhde
Florian S. Gutzwiller
Leif Jörgensen
Kjell Larsson
Publication date
01-12-2018
Publisher
BioMed Central
Published in
Respiratory Research / Issue 1/2018
Electronic ISSN: 1465-993X
DOI
https://doi.org/10.1186/s12931-018-0868-y

Other articles of this Issue 1/2018

Respiratory Research 1/2018 Go to the issue

Letter to the Editor

Prediction equations of forced oscillation technique: the insidious role of collinearity

Research

Elastin degradation products in acute lung injury induced by gastric contents aspiration

Editorial

Healthier without healthcare? The paradox of the common cold

Research

Effects and molecular mechanisms of intrauterine infection/inflammation on lung development

Letter to the Editor

Human alveolar macrophages predominately express combined classical M1 and M2 surface markers in steady state

Review

The use of intravenous versus subcutaneous monoclonal antibodies in the treatment of severe asthma: a review

ACC 2024 Congress Coverage

Cardiology Video

Highlights from the ACC 2024 Congress

Watch now

Watch official videos from the ACC congress summarizing key highlights from the last year in heart failure, cardiomyopathies, valvular disease, pulmonary vascular disease, and pediatric cardiology.

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits