Observational study of inhaled corticosteroids on outcomes for COPD patients with pneumonia

Dennis Chen, Marcos I. Restrepo, Michael J. Fine, Mary Jo V Pugh, Antonio Anzueto, Mark L. Metersky, Brandy Nakashima, Chester Good, Eric M. Mortensen

Research output: Contribution to journalArticle

64 Citations (Scopus)

Abstract

Rationale: 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. Objectives: The aim of this study was to examine the effects of prior use of ICS 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 preexisting diagnosis of COPD, had a discharge diagnosis of pneumonia, and received treatment with one or more appropriate pulmonary medications before hospitalization. Outcomes included mortality, use of invasive mechanical ventilation, and vasopressor use. Measurements and Main Results: There were 15,768 patients (8,271 with use of ICS and 7,497 with no use of ICS) 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 use of ICS is independently associated with decreased risk of short-term mortality and use of mechanical ventilation after hospitalization for pneumonia.

Original languageEnglish (US)
Pages (from-to)312-316
Number of pages5
JournalAmerican Journal of Respiratory and Critical Care Medicine
Volume184
Issue number3
DOIs
StatePublished - Aug 1 2011

Fingerprint

Chronic Obstructive Pulmonary Disease
Observational Studies
Pneumonia
Adrenal Cortex Hormones
Odds Ratio
Artificial Respiration
Mortality
Confidence Intervals
Hospitalization
Multilevel Analysis
Veterans
Cohort Studies
Retrospective Studies
Regression Analysis
Databases
Lung
Incidence
Therapeutics

Keywords

  • Chronic obstructive pulmonary disease
  • Inhaled corticosteroids
  • Mortality
  • Pneumonia

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine

Cite this

Observational study of inhaled corticosteroids on outcomes for COPD patients with pneumonia. / Chen, Dennis; Restrepo, Marcos I.; Fine, Michael J.; Pugh, Mary Jo V; Anzueto, Antonio; Metersky, Mark L.; Nakashima, Brandy; Good, Chester; Mortensen, Eric M.

In: American Journal of Respiratory and Critical Care Medicine, Vol. 184, No. 3, 01.08.2011, p. 312-316.

Research output: Contribution to journalArticle

Chen, Dennis ; Restrepo, Marcos I. ; Fine, Michael J. ; Pugh, Mary Jo V ; Anzueto, Antonio ; Metersky, Mark L. ; Nakashima, Brandy ; Good, Chester ; Mortensen, Eric M. / Observational study of inhaled corticosteroids on outcomes for COPD patients with pneumonia. In: American Journal of Respiratory and Critical Care Medicine. 2011 ; Vol. 184, No. 3. pp. 312-316.
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KW - Inhaled corticosteroids

KW - Mortality

KW - Pneumonia

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