S113 The risk of pneumonia in COPD patients with concomitant bronchiectasis using inhaled corticosteroids: a UK case-control study. (11th November 2022)

• Record Type: Journal Article
• Authors: Ritchie, AI; Singanayagam, A; Mitchell, S; Wedzicha, J; Shah, A; Bloom, C
• Is Part Of: Thorax. Volume 77(2022)Supplement 1
• Page Start: A70
• Page End: A70
• Publication Date: 2022-11-11
• Subjects: Chest -- Diseases -- Periodicals; Thorax; Chest -- Diseases; Periodicals; Periodicals; 617.54
• DOI: 10.1136/thorax-2022-BTSabstracts.119
• Languages: English
• ISSNs: 0040-6376

Abstract

Abstract : Introduction and Objectives: Inhaled corticosteroids (ICS) are commonly prescribed in COPD to reduce the risk of exacerbations. However, their use is associated with community acquired pneumonia (CAP) and recent guidance suggests that their prescription should be confined to those with frequent exacerbations and raised eosinophils. Patients with COPD and concomitant bronchiectasis are a group in which the risk-benefit ratio of ICS use is poorly defined. Given the high frequency of lower airways colonisation associated with bronchiectasis, we hypothesised that ICS use would be associated with increased risk of CAP in these individuals. Methods: Population-based case-control study, 2004 to 2019, using nationwide electronic healthcare records (Clinical Practice Research Datalink). Cases and controls were nested from a cohort of COPD patients with no ICS use at the start of follow-up. Cases were hospitalised for CAP (identified using Hospital Episode Statistics admission data), controls were matched on the same day (index day), ratio 1:4 by age and gender. Multivariable conditional logistic regression was used to determine effect estimates. Likelihood ratio test assessed bronchiectasis as an effect modifier. Results: From 187, 277 in the COPD cohort, we identified 20, 195 cases hospitalised with CAP and 61, 121 controls. Use of ICS was associated with 26% increased odds of CAP (AOR=1.26, 95% CI 1.19–1.32). More recent ICS use was more strongly associated with pneumonia, such that there was no increased risk from ICS used between 180 and 365 days before the index date ( table 1 ). Concomitant bronchiectasis was found to significantly interact with the association between ICS and CAP in COPD patients (p<0.01). In those with concomitant bronchiectasis, ICS was not significantly associated with hospitalised CAP (AOR=1.01, 95% CI 0.8–1.28), however, in COPD patients without bronchiectasis, there was 27% increased odds of CAP (AOR=1.27, 95% CI, 1.20–1.34). Conclusions: Whilst bronchiectasis is known to confer an increased risk of hospitalised CAP in COPD, the use of ICS does not confer a further increased risk. To our knowledge this is the first study to provide data to support the latest European Respiratory Society adult bronchiectasis guidelines that ICS should not be withdrawn from patients with established COPD-bronchiectasis overlap.