The aim of this study was to investigate if inhaled corticosteroid(ICS) use impacts on outcome in patients with chronic obstructive pulmonary disease(COPD) admitted with community-acquired pneumonia(CAP).
A prospective observational study of patients with spirometry-confirmed COPD presenting with a primary diagnosis of CAP in Lothian,UK. Outcome measures were compared between ICS users and non-users. Of 490 patients included in the study, 76.7% were classified as ICS users. ICS users had higher GOLD stage compared with non-users (mean(SD) 3.2(0.8) vs 2.6(0.9); p<0.0001).
There were no significant differences in pneumonia severity (mean(SD) pneumonia severity index(PSI) 4.2(0.8) vs 4.3(0.8), p=0.3; mean(SD) CURB65 score 2.1(1.3) vs 2.3(1.3), p=0.07) or markers of systemic inflammation (median CRP 148(58-268) vs 183(85-302) mg·L(-1); p=0.08 ) between ICS users and non-users. On multivariable analysis, after adjustment for COPD severity and PSI, ICS use was not independently associated with 30-day mortality (OR 1.71 [95% CI 0.75-3.90], p=0.2), 6-month mortality (OR 1.62 [95% CI 0.82-3.16], p=0.2), requirement for mechanical ventilation and/or inotropic support (OR 0.73 [95% CI 0.33-1.62], p=0.4) or development of complicated pneumonia (OR 0.71 [95% CI 0.25-1.99], p=0.5).
Prior ICS use has no impact on outcome in patients with COPD admitted with CAP.
