Abstract
BackgroundThe role of inhaled steroids in patients with chronic respiratory diseases is a matter of debate due to the potential effect on the development and prognosis of community-acquired pneumonia (CAP). We assessed whether treatment with inhaled steroids in patients with chronic bronchitis, COPD or asthma and CAP may affect early outcome of the acute pneumonic episode.MethodsOver 1-year period, all population-based cases of CAP in patients with chronic bronchitis, COPD or asthma were registered. Use of inhaled steroids were registered and patients were followed up to 30 days after diagnosis to assess severity of CAP and clinical course (hospital admission, ICU admission and mortality).ResultsOf 473 patients who fulfilled the selection criteria, inhaled steroids were regularly used by 109 (23%). In the overall sample, inhaled steroids were associated with a higher risk of hospitalization (OR=1.96, p = 0.002) in the bivariate analysis, but this effect disappeared after adjusting by other severity-related factors (adjusted OR=1.08, p=0.787). This effect on hospitalization also disappeared when considering only patients with asthma (OR=1.38, p=0.542), with COPD alone (OR=4.68, p=0.194), but a protective effect was observed in CB patients (OR=0.15, p=0.027). Inhaled steroids showed no association with ICU admission, days to clinical recovery and mortality in the overall sample and in any disease subgroup.ConclusionsTreatment with inhaled steroids is not a prognostic factor in COPD and asthmatic patients with CAP, but could prevent hospitalization for CAP in patients with clinical criteria of chronic bronchitis.
Highlights
Community-acquired pneumonia (CAP) remains an important cause of morbidity and mortality in industrialised countries, with a hospitalization rate between 22% and 51% [1,2] and a lethality rate between 3% and 24% [3,4]
Treatment with inhaled steroids was significantly associated with hospital admission, doubling the estimated risk of admission in relation to the patients without treatment
This has been analysed in different studies, such as the TOwards a Revolution in COPD Health (TORCH) study [7] in which a lower mortality in chronic obstructive pulmonary disease (COPD) patients with community-acquired pneumonia (CAP) previously treated with inhaled steroids was found
Summary
Community-acquired pneumonia (CAP) remains an important cause of morbidity and mortality in industrialised countries, with a hospitalization rate between 22% and 51% [1,2] and a lethality rate between 3% and 24% [3,4]. Some authors have shown a reduction of mortality in COPD patients treated with inhaled steroids [12,13] This had led to speculation that the use of inhaled steroids may increase the risk for CAP but protect against severe pneumonia or pneumonia-related complications [14,15]. In the overall sample, inhaled steroids were associated with a higher risk of hospitalization (OR=1.96, p = 0.002) in the bivariate analysis, but this effect disappeared after adjusting by other severity-related factors (adjusted OR=1.08, p=0.787). This effect on hospitalization disappeared when considering only patients with asthma (OR=1.38, p=0.542), with COPD alone (OR=4.68, p=0.194), but a protective effect was observed in CB patients (OR=0.15, p=0.027). Conclusions: Treatment with inhaled steroids is not a prognostic factor in COPD and asthmatic patients with CAP, but could prevent hospitalization for CAP in patients with clinical criteria of chronic bronchitis
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