Observational Study of Inhaled Corticosteroids on Outcomes for COPD Patients with Pneumonia.
Am J Respir Crit Care Med. 2011 Apr 21;
Authors: Chen D, Restrepo MI, Fine MJ, Pugh MJ, Anzueto A, Metersky ML, Nakashima B, Good C, Mortensen EM
BACKGROUND: Treatment with inhaled corticosteroids (ICS) for those with chronic obstructive pulmonary disease (COPD) has been shown to be associated with an increased incidence of pneumonia. However, it is unclear if this is associated with increased mortality. The aim of this study was to examine the effects of prior ICS use on clinical outcomes for patients with COPD hospitalized with pneumonia. METHODS: We conducted a retrospective cohort study using the national administrative databases of the Department of Veterans Affairs. Eligible patients had a pre-existing diagnosis of COPD, a discharge diagnosis of pneumonia, and received treatment with one or more appropriate pulmonary medications prior to hospitalization. Outcomes included mortality, use of invasive mechanical ventilation, and vasopressor use. RESULTS: There were 15,768 patients (8,271 with ICS use, 7,497 no ICS use) with COPD who were hospitalized for pneumonia. There was also a significant difference for 90-day mortality (ICS: 17.3% vs. No ICS: 22.8%, p<0.001). Multilevel regression analyses demonstrated that prior receipt of ICS was associated with decreased mortality at 30 days (odds ratio [OR] 0.80, 95% confidence interval [CI] 0.72-0.89) and 90 days (OR 0.78, 95% CI 0.72-0.85), and decreased use of mechanical ventilation (OR 0.83, 95% CI 0.72-0.94). There was no significant association between receipt of ICS and vasopressor use (OR 0.88, 95% CI 0.74-1.04) CONCLUSIONS: For patients with COPD, prior ICS use is independently associated with decreased risk of short-term mortality and use of mechanical ventilation following hospitalization for pneumonia.
PMID: 21512168 [PubMed - as supplied by publisher]