Inhaled corticosteroid dose is associated with Pseudomonas aeruginosa infection in severe COPD
Introduction Patients with chronic obstructive pulmonary disease (COPD) with frequent exacerbations (ExCOPD) are commonly treated with inhaled corticosteroids (ICS) and are at risk of infections caused by potential pathogenic bacteria (PPB) including Pseudomonas aeruginosa (PsA).Objectives To invest...
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BMJ Publishing Group
2021-01-01
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| Series: | BMJ Open Respiratory Research |
| Online Access: | https://bmjopenrespres.bmj.com/content/8/1/e001067.full |
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| author | Antonio Oliver Borja G Cosío Hanaa Shafiek Javier Verdú Amanda Iglesias Lluisa Ramon-Clar Nuria Toledo-Pons Carla Lopez-Causape Carlos Juan Pablo Fraile-Ribot |
| author_facet | Antonio Oliver Borja G Cosío Hanaa Shafiek Javier Verdú Amanda Iglesias Lluisa Ramon-Clar Nuria Toledo-Pons Carla Lopez-Causape Carlos Juan Pablo Fraile-Ribot |
| author_sort | Antonio Oliver |
| collection | DOAJ |
| description | Introduction Patients with chronic obstructive pulmonary disease (COPD) with frequent exacerbations (ExCOPD) are commonly treated with inhaled corticosteroids (ICS) and are at risk of infections caused by potential pathogenic bacteria (PPB) including Pseudomonas aeruginosa (PsA).Objectives To investigate the association between the use of ICS and PsA infection among ExCOPD.Methods Case–control study with longitudinal follow-up that recruited ExCOPD after a hospitalisation due to exacerbation between 2012 and 2020. Patients with isolation of PsA (COPD-PsA) in sputum either during admission or follow-up were compared with those with other or no PPB. Clinical, functional characteristics, DDD, use of ICS and survival were evaluated. Cox regression analysis was performed to evaluate the risk factors associated to PsA infection and mortality.Results 358 patients (78% male, mean age 73±9 years) were enrolled and followed up for a median of 4 years (IQR=3–8). 173 patients (48.3%) had at least a positive culture for PsA. COPD-PsA had more frequent exacerbations, more severe airflow limitation and higher mortality (69.4% vs 46.5%, p<0.001). There were no differences in the use of ICS between groups but the dose of ICS was significantly higher among COPD-PsA (median of 500 µg fluticasone propionate equivalents (IQR=250–1000) vs 400 µg (IQR=200–1000), p=0.007). Blood eosinophil count (BEC) was not different between ICS users and non-users. In multivariate analysis, the dose of ICS was an independent risk factor for PsA infection and mortality but not ICS use.Conclusions ICS dose, but not its use, could be a risk factor for PsA infection in patients with severe COPD regardless of BEC. |
| format | Article |
| id | doaj-art-286bf727931b4b03a9a6df93cb64cff7 |
| institution | OA Journals |
| issn | 2052-4439 |
| language | English |
| publishDate | 2021-01-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open Respiratory Research |
| spelling | doaj-art-286bf727931b4b03a9a6df93cb64cff72025-08-20T02:22:20ZengBMJ Publishing GroupBMJ Open Respiratory Research2052-44392021-01-018110.1136/bmjresp-2021-001067Inhaled corticosteroid dose is associated with Pseudomonas aeruginosa infection in severe COPDAntonio Oliver0Borja G Cosío1Hanaa Shafiek2Javier Verdú3Amanda Iglesias4Lluisa Ramon-Clar5Nuria Toledo-Pons6Carla Lopez-Causape7Carlos Juan8Pablo Fraile-Ribot9Department of Clinical Microbiology, Hospital Universitario Son Espases, Palma de Mallorca, SpainCentro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Madrid, Spain1Department of Respiratory Medicine, Hospital Universitario Son Espases and Instituto de Investigación Sanitaria de Palma (IdISPa), Palma de Mallorca, SpainDepartment of Respiratory Medicine, Hospital Universitario Son Espases, Palma de Mallorca, SpainCIBERES, Instituto de Salud Carlos III, Madrid, SpainDepartment of Respiratory Medicine, Hospital Universitario Son Espases, Palma de Mallorca, SpainDepartment of Respiratory Medicine, Hospital Universitario Son Espases, Palma de Mallorca, SpainInstituto de Investigación Sanitaria de las Islas Baleares (IdISBa), Palma de Mallorca, SpainInstituto de Investigación Sanitaria de las Islas Baleares (IdISBa), Palma de Mallorca, SpainInstituto de Investigación Sanitaria de las Islas Baleares (IdISBa), Palma de Mallorca, SpainIntroduction Patients with chronic obstructive pulmonary disease (COPD) with frequent exacerbations (ExCOPD) are commonly treated with inhaled corticosteroids (ICS) and are at risk of infections caused by potential pathogenic bacteria (PPB) including Pseudomonas aeruginosa (PsA).Objectives To investigate the association between the use of ICS and PsA infection among ExCOPD.Methods Case–control study with longitudinal follow-up that recruited ExCOPD after a hospitalisation due to exacerbation between 2012 and 2020. Patients with isolation of PsA (COPD-PsA) in sputum either during admission or follow-up were compared with those with other or no PPB. Clinical, functional characteristics, DDD, use of ICS and survival were evaluated. Cox regression analysis was performed to evaluate the risk factors associated to PsA infection and mortality.Results 358 patients (78% male, mean age 73±9 years) were enrolled and followed up for a median of 4 years (IQR=3–8). 173 patients (48.3%) had at least a positive culture for PsA. COPD-PsA had more frequent exacerbations, more severe airflow limitation and higher mortality (69.4% vs 46.5%, p<0.001). There were no differences in the use of ICS between groups but the dose of ICS was significantly higher among COPD-PsA (median of 500 µg fluticasone propionate equivalents (IQR=250–1000) vs 400 µg (IQR=200–1000), p=0.007). Blood eosinophil count (BEC) was not different between ICS users and non-users. In multivariate analysis, the dose of ICS was an independent risk factor for PsA infection and mortality but not ICS use.Conclusions ICS dose, but not its use, could be a risk factor for PsA infection in patients with severe COPD regardless of BEC.https://bmjopenrespres.bmj.com/content/8/1/e001067.full |
| spellingShingle | Antonio Oliver Borja G Cosío Hanaa Shafiek Javier Verdú Amanda Iglesias Lluisa Ramon-Clar Nuria Toledo-Pons Carla Lopez-Causape Carlos Juan Pablo Fraile-Ribot Inhaled corticosteroid dose is associated with Pseudomonas aeruginosa infection in severe COPD BMJ Open Respiratory Research |
| title | Inhaled corticosteroid dose is associated with Pseudomonas aeruginosa infection in severe COPD |
| title_full | Inhaled corticosteroid dose is associated with Pseudomonas aeruginosa infection in severe COPD |
| title_fullStr | Inhaled corticosteroid dose is associated with Pseudomonas aeruginosa infection in severe COPD |
| title_full_unstemmed | Inhaled corticosteroid dose is associated with Pseudomonas aeruginosa infection in severe COPD |
| title_short | Inhaled corticosteroid dose is associated with Pseudomonas aeruginosa infection in severe COPD |
| title_sort | inhaled corticosteroid dose is associated with pseudomonas aeruginosa infection in severe copd |
| url | https://bmjopenrespres.bmj.com/content/8/1/e001067.full |
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