Chronic use of inhaled corticosteroids in patients admitted for respiratory virus infections: a 6-year prospective multicenter study

David Luque-Paz,Lisa M Colosi ,M Cailleaux,M Revest,Laurent Pereira ,Sabrina Cochennec ,Anne-Sophie L’Honneur,F Dumas,E Nyiramigisha,S Alcolea,Vincent Foulongne,Pierre Loulergue ,L Landreau,S Rochas,H Blain,Hervé Mal ,A Pelletier ,B Doumenc,Matthieu Lilamand ,M Ranaivoision,C Chansiaux,Julie Bernard ,M Chauchard,C Agostini,A.-C Metivier,Gisèle Lagathu,Delanoe Delanoe,Xavier Duval,Marie Lachâtre ,B Crestani,R Kanaan,P Ralainnazava,N Douron,A Raynaud-Simon,Fabrice Lainé,T Mura,K Oplelatora,A Le Bot,A Dossier,Philippe Géraud ,C Fernet,Corinne Merle ,Julien Charpentier ,C Bui-Xuan,A Marceau,A Giordano,H Chevassus,A Leleu,Sophie Alain,François Bénézit,T Szwebel,Philippe Vanhems,Tiphaine Goulenok ,K Belghalem,M Cour,I Lerat,C Rioux,H Becheur,Zineb Lesieur,E Dupeyrat,M Ray,Thomas Papo ,S Rogez,N Houhou,Charles Burdet ,S Noslier,Odile Launay,Paul Loubet,N Lenzi,A Terminet,Jean-François Alexandra ,P Chavance,Mustapha Sebbane ,Elise Thébault ,D Postil,R Bories,Martial Boisseau ,G Mourad,Y Yazdapanah,H Leray,Karim Sacré ,F Brunet,L Crantelle,B Couset,S Amour ,Bruno Lina,A Konaté,Marie-Suzanne Leglise ,M Caseris,G Du Cailar,Elodie Couvé-Deacon ,N Marin,S Jouneau,A Regent,Christine Vallejo,Alain Bourdin ,V Verry,X Capdevilla,Stefan Momčilović ,P Corne,L Argaud,F Letois,Pierre Tattevin,Martine Valette ,Enrique Casalino ,A Justet,Pauline Pradère ,M Baldeyrou,Charlotte Pronier ,F Crocket,Vincent Thibault,Kada Klouche ,R Hernu,Nadhira Fidouh,J P Mira,Stanislas Harent ,N Emeyrat,V Descamps,C Serrand,V Driss,A Le Quellec,Ahmed Debit ,A Cloppet-Fontaine,S Patrat-Delon,V Vuong,J Kansao,Alexandre Bleibtreu ,K Tazarourte,Yago Pessoa Costa ,R Jouenne,T Baudry,A Bourgeois,P Dieude,V Maugueret,Prommier Prommier,M Sébillotte,J Fattoum,M Simon,Christophe Choquet ,Olivier Brugière ,Florence Galtier

doi:10.1038/s41598-022-08089-0

Abstract

Inhaled corticosteroids (ICS) have been associated with increased risk of pneumonia. Their impact on respiratory virus infections is unclear. We performed a post-hoc analysis of the FLUVAC cohort, a multicenter prospective cohort study of adults hospitalized with influenza-like illness (ILI) during six consecutive influenza seasons (2012–2018). All patients were tested for respiratory virus infection by multiplex PCR on nasopharyngeal swabs and/or bronchoalveolar lavage. Risk factors were identified by logistic regression analysis. Among the 2658 patients included, 537 (20.2%) were treated with ICS before admission, of whom 282 (52.5%, 282/537) tested positive for at least one respiratory virus. Patients on ICS were more likely to test positive for non-influenza respiratory viruses (25.1% vs. 19.5%, P = 0.004), especially for adenovirus (aOR 2.36, 95% CI 1.18–4.58), and respiratory syncytial virus (aOR 2.08, 95% CI 1.39–3.09). Complications were reported in 55.9% of patients on ICS (300/537), primarily pneumonia (171/535, 32%). Among patients on chronic ICS who tested positive for respiratory virus, 14.2% (40/282) were admitted to intensive care unit, and in-hospital mortality rate was 2.8% (8/282). Chronic use of ICS is associated with an increased risk of adenovirus or RSV infections in patients admitted for ILI.

Highlights

Inhaled corticosteroids (ICS) have been associated with increased risk of pneumonia
Of the 3156 patients included in the FLUVAC study, 2658 (84.2%, 95% confidence intervals (95% CI) 49–53) had complete data on chronic use of ICS, and results of respiratory viruses testing (Fig. 1)
In this post-hoc analysis of 2,658 adult patients hospitalized for community-acquired influenza-like illness (ILI) and tested for respiratory virus infections by multiplex PCR, we found that chronic use of ICS was associated with increased risk of non-influenza respiratory virus (NIRV) infections, adenovirus and respiratory syncytial virus (RSV)

Summary

Introduction

Inhaled corticosteroids (ICS) have been associated with increased risk of pneumonia. Their impact on respiratory virus infections is unclear. Chronic use of ICS is associated with an increased risk of adenovirus or RSV infections in patients admitted for ILI. Abbreviations ARDS Acute respiratory distress syndrome BMI Body mass index COPD Chronic obstructive pulmonary disease ICS Inhaled corticosteroids ICU Intensive care unit ILI Influenza-like illness IQR Interquartile range NIRV Non-influenza respiratory viruses RSV Respiratory syncytial virus SD Standard deviation. We aimed to compare the characteristics and outcome of respiratory virus infections in adults hospitalized for influenza-like illness (ILI) with, or without, chronic use of ICS

Objectives

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Conclusion