The Association between Use of ICS and Psychiatric Symptoms in Patients with COPD-A Nationwide Cohort Study of 49,500 Patients.

Alexander Jordan,Jakob B Vestergaard,Anders Løkke,Mohamad Isam Saeed,Tor Biering-Sørensen,Niels Seersholm,Howraman Meteran,Josefin Eklöf,Pradeesh Sivapalan,Jens Ulrik Stæhr Jensen

doi:10.3390/biomedicines9101492

Alexander Jordan, Jakob B Vestergaard + Show 8 more

Open Access

https://doi.org/10.3390/biomedicines9101492

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Abstract

Psychiatric side effects are well known from treatment with systemic corticosteroids. It is, however, unclear whether inhaled corticosteroids (ICS) have psychiatric side effects in patients with COPD. We conducted a nationwide cohort study in all Danish COPD outpatients who had respiratory medicine specialist-verified COPD, age ≥40 years, and no previous cancer. Prescription fillings of antidepressants and risk of admissions to psychiatric hospitals with either depression, anxiety or bipolar disorder were assessed by Cox proportional hazards models. We observed a dose-dependent increase in the risk of antidepressant-use with ICS cumulated dose (HR 1.05, 95% CI 1.03–1.07, p = 0.0472 with low ICS exposure, HR 1.10, 95% CI 1.08–1.12, p < 0.0001 with medium exposure, HR 1.15, 95% CI 1.11–1.15, p < 0.0001 with high exposure) as compared to no ICS exposure. We found a discrete increased risk of admission to psychiatric hospitals in the medium and high dose group (HR 1.00, 95% CI 0.98–1.03, p = 0.77 with low ICS exposure, HR 1.07, 95% CI 1.05–1.10, p < 0.0001 with medium exposure, HR 1.13, 95% CI 1.10–1.15, p < 0.0001 with high exposure). The association persisted when stratifying for prior antidepressant use. Thus, exposure to ICS was associated with a small to moderate increase in antidepressant-use and psychiatric admissions.

Highlights

Chronic obstructive pulmonary disease (COPD) is one of the leading causes of death worldwide
The risk of collection of any antidepressant or death by any cause showed a small dose- dependent association with Inhaled corticosteroids (ICS) dose ((HR 1.05, 95% confidence intervals (CI) 1.03–1.07, p = 0.0472 with low ICS exposure, hazard ratios (HR) 1.10, 95% CI 1.08–1.12, p < 0.0001 with medium exposure, HR 1.15, 95% CI 1.11–1.15, p < 0.0001 with high exposure) as compared to no ICS exposure, Table 2 and Figure 2)
The risk of admission to a psychiatric hospital or death by any cause increased in the medium and high ICS groups, but statistically insignificant in the low group when compared with the no ICS group

Summary

Introduction

Chronic obstructive pulmonary disease (COPD) is one of the leading causes of death worldwide. ICS treatment generally has fewer side-effects than treatment with oral corticosteroids (OCS). Treatment with ICS has been associated with some of the same side effects known from systemic corticosteroid treatment, such as cataract [1,2] and pneumonia [3,4,5,6]. These side effects are thought to be either due to corticosteroids entering the bloodstream through the lungs or through the gastrointestinal tract or via a localized effect directly on the lungs. The extent of the side effects seems to vary between ICS type, dose, and delivery methods [7,8]

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