ArticlePloS one2014
Risk of pneumonia with inhaled corticosteroid versus long-acting bronchodilator regimens in chronic obstructive pulmonary disease: a new-user cohort study.
Article in PloS one, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 28 papers.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
28 citing papers in PubMed, 59 citations in OpenAlex.
- Concomitant inhaled corticosteroid use and the risk of pneumonia in COPD: a matched-subgroup post hoc analysis of the UPLIFT® trial.Respiratory research · 2018Trial
- Indacaterol/glycopyrronium versus salmeterol/fluticasone in Asian patients with COPD at a high risk of exacerbations: results from the FLAME study.International journal of chronic obstructive pulmonary disease · 2017Trial
- LANTERN: a randomized study of QVA149 versus salmeterol/fluticasone combination in patients with COPD.International journal of chronic obstructive pulmonary disease · 2015Trial
- Review
- A lactobacilli-based inhaled live biotherapeutic product attenuates pulmonary neutrophilic inflammation.Nature communications · 2024Article
- Accuracy of the recording of pneumonia events in English electronic healthcare record data in patients with chronic obstructive pulmonary disease.Pneumonia (Nathan Qld.) · 2024Article
- The adherence to and utility of the Global Initiative for Chronic Obstructive Lung Disease guidelines for treating COPD among pulmonary specialists: a retrospective analysis.BMC pulmonary medicine · 2023Article
- Blood eosinophils to guide inhaled maintenance therapy in a primary care COPD population.ERJ open research · 2022Article
- COPD patients prescribed inhaled corticosteroid in primary care: time for re-assessment based on exacerbation rate and blood eosinophils?Respiratory research · 2021Article
- Electronic Medical Record-Based Case Phenotyping for the Charlson Conditions: Scoping Review.JMIR medical informatics · 2021Article
- Treatment Patterns of New Users of Fluticasone Furoate/Vilanterol in Asthma and COPD in UK Primary Care: Retrospective Cohort Study.Pulmonary therapy · 2019Article
- Pneumonia in Patients with Chronic Obstructive Pulmonary Disease.Tuberculosis and respiratory diseases · 2018Review
- Exacerbations of COPD.European respiratory review : an official journal of the European Respiratory Society · 2018Review
- Inhaled therapies in patients with moderate COPD in clinical practice: current thinking.International journal of chronic obstructive pulmonary disease · 2018Review
- Inhaled corticosteroids for chronic obstructive pulmonary disease: what is their role in therapy?International journal of chronic obstructive pulmonary disease · 2018Review
- Risk of community-acquired pneumonia in chronic obstructive pulmonary disease stratified by smoking status: a population-based cohort study in the United Kingdom.International journal of chronic obstructive pulmonary disease · 2017Article
- Assessment of channeling bias among initiators of glucose-lowering drugs: A UK cohort study.Clinical epidemiology · 2017Article
- First maintenance therapy for COPD in the UK between 2009 and 2012: a retrospective database analysis.NPJ primary care respiratory medicine · 2016Article
- Pharmacological strategies to reduce exacerbation risk in COPD: a narrative review.Respiratory research · 2016Review
- Inhaled corticosteroids and the increased risk of pneumonia: what's new? A 2015 updated review.Therapeutic advances in respiratory disease · 2016Review
Corrections and comments
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Authors and funding
6 authors at 3 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionObservational studies using case-control designs have showed an increased risk of pneumonia associated with inhaled corticosteroid (ICS)-containing medications in patients with chronic obstructive pulmonary disease (COPD). New-user observational cohort designs may minimize biases associated with previous case-control designs.
objectiveTo estimate the association between ICS and pneumonia among new users of ICS relative to inhaled long-acting bronchodilator (LABD) monotherapy.
methodsPneumonia events in COPD patients ≥45 years old were compared among new users of ICS medications (n = 11,555; ICS, ICS/long-acting β2-agonist [LABA] combination) and inhaled LABD monotherapies (n = 6,492; LABA, long-acting muscarinic antagonists) using Cox proportional hazards models, with propensity scores to adjust for confounding.
settingUnited Kingdom electronic medical records with linked hospitalization and mortality data (2002-2010). New users were censored at earliest of: pneumonia event, death, changing/discontinuing treatment, or end of follow-up. OUTCOMES: severe pneumonia (primary) and any pneumonia (secondary).
resultsFollowing adjustment, new use of ICS-containing medications was associated with an increased risk of pneumonia hospitalization (n = 322 events; HR = 1.55, 95% CI: 1.14, 2.10) and any pneumonia (n = 702 events; HR = 1.49, 95% CI: 1.22, 1.83). Crude incidence rates of any pneumonia were 48.7 and 30.9 per 1000 person years among the ICS-containing and LABD cohorts, respectively. Excess risk of pneumonia with ICS was reduced when requiring ≥1 month or ≥ 6 months of new use. There was an apparent dose-related effect, with greater risk at higher daily doses of ICS. There was evidence of channeling bias, with more severe patients prescribed ICS, for which the analysis may not have completely adjusted.
conclusionsThe results of this new-user cohort study are consistent with published findings; ICS were associated with a 20-50% increased risk of pneumonia in COPD, which reduced with exposure time. This risk must be weighed against the benefits when prescribing ICS to patients with COPD.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.