Risk of pneumonia in obstructive lung disease: A real-life study comparing extra-fine and fine-particle inhaled corticosteroids
Professor: Ulla Møller Weinreich
Kommentar til artiklen:
Der tilkommer stadig flere inhalationsmedicinske præparater til vore obstruktivt lungesyge patienter. Som udvalget stiger, stiger vores samfunds behov for at styre medicinudgifterne. De studier, der foreligger på præparaterne, er oftest initierede af de lancerende firmaer, og er derfor designede til at undersøge, hvad er nødvendigt efter firmaets behov. Dette real-life studie undersøger risikoen for pneumoni hos pt som har benyttet fine, resp ekstrafine corticosteroid inhalationspræparater og indikerer, at pt, som benytter sig af ekstra-fine partikler, får færre pneumonier. Vi har behov for real life studier, som følger op på effekten af medicinen, når den benyttes i praksis.
Regular use of inhaled corticosteroids (ICS) in patients with obstructive lung diseases has been associated with a higher risk of pneumonia, particularly in COPD. The risk of pneumonia has not been previously evaluated in relation to ICS particle size and dose used.
Historical cohort, UK database study of 23,013 patients with obstructive lung disease aged 12–80 years prescribed extra-fine or fine-particle ICS. The endpoints assessed during the outcome year were diagnosis of pneumonia, acute exacerbations and acute respiratory events in relation to ICS dose. To determine the association between ICS particle size, dose and risk of pneumonia in unmatched and matched treatment groups, logistic and conditional logistic regression models were used.
14788 patients were stepped-up to fine-particle ICS and 8225 to extra-fine ICS. On unmatched analysis, patients stepping-up to extra-fine ICS were significantly less likely to be coded for pneumonia (adjusted odds ratio [aOR] 0.60; 95% CI 0.37, 0.97]); experience acute exacerbations (adjusted risk ratio [aRR] 0.91; 95%CI 0.85, 0.97); and acute respiratory events (aRR 0.90; 95%CI 0.86, 0.94) compared with patients stepping-up to fine-particle ICS. Patients prescribed daily ICS doses in excess of 700 mcg (fluticasone propionate equivalent) had a significantly higher risk of pneumonia (OR [95%CI] 2.38 [1.17, 4.83]) compared with patients prescribed lower doses, irrespective of particle size.
These findings suggest that patients with obstructive lung disease on extra-fine particle ICS have a lower risk of pneumonia than those on fine-particle ICS, with those receiving higher ICS doses being at a greater risk.