Inhaled corticosteroids and risk of lower respiratory tract infection with Moraxella catarrhalis in patients with chronic obstructive pulmonary disease
Background Use of inhaled corticosteroids (ICS) is common in patients with chronic obstructive pulmonary disease (COPD) and has been associated with an increased risk of pneumonia. Moraxella catarrhalis is one of the most common bacterial causes of infectious exacerbation in COPD. Currently, to our...
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
2023-11-01
|
| Series: | BMJ Open Respiratory Research |
| Online Access: | https://bmjopenrespres.bmj.com/content/10/1/e001726.full |
| _version_ | 1797368709464981504 |
|---|---|
| author | Pradeesh Sivapalan Josefin Eklöf Jens-Ulrik Stæhr Jensen Christian Østergaard Jonas Bredtoft Boel Ram Benny Dessau Christian Kjer Heerfordt Rikke Helin Johnsen |
| author_facet | Pradeesh Sivapalan Josefin Eklöf Jens-Ulrik Stæhr Jensen Christian Østergaard Jonas Bredtoft Boel Ram Benny Dessau Christian Kjer Heerfordt Rikke Helin Johnsen |
| author_sort | Pradeesh Sivapalan |
| collection | DOAJ |
| description | Background Use of inhaled corticosteroids (ICS) is common in patients with chronic obstructive pulmonary disease (COPD) and has been associated with an increased risk of pneumonia. Moraxella catarrhalis is one of the most common bacterial causes of infectious exacerbation in COPD. Currently, to our knowledge, no studies have investigated if ICS increases the risk of lower respiratory tract infection with M. catarrhalis in patients with COPD.Objective To investigate if accumulated ICS use in patients with COPD, is associated with a dose-dependent risk of infection with M. catarrhalis.Methods This observational cohort study included 18 870 persons with COPD who were registered in The Danish Register of COPD. Linkage to several nationwide registries was performed.Exposure to ICS was determined by identifying all prescriptions for ICS, redeemed within 365 days prior to study entry. Main outcome was a lower respiratory tract sample positive for M. catarrhalis. For the main analysis, a Cox multivariate regression model was used.We defined clinical infection as admission to hospital and/or a redeemed prescription for a relevant antibiotic, within 7 days prior to 14 days after the sample was obtained.Results We found an increased, dose-dependent, risk of a lower respiratory tract sample with M. catarrhalis among patients who used ICS, compared with non-users. For low and moderate doses of ICS HR was 1.65 (95% CI 1.19 to 2.30, p=0.003) and 1.82 (95% CI 1.32 to 2.51, p=0.0002), respectively. In the group of patients with highest ICS exposure, the HR of M. catarrhalis was 2.80 (95% CI 2.06 to 3.82, p<0.0001). Results remained stable in sensitivity analyses. 87% of patients fulfilled the criteria for clinical infection, and results remained unchanged in this population.Conclusion Our study shows a dose-dependent increased risk of infection with M. catarrhalis associated to ICS exposure. |
| first_indexed | 2024-03-08T17:36:35Z |
| format | Article |
| id | doaj.art-185a2778fd354bd9b2e62820a93b0f56 |
| institution | Directory Open Access Journal |
| issn | 2052-4439 |
| language | English |
| last_indexed | 2024-03-08T17:36:35Z |
| publishDate | 2023-11-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open Respiratory Research |
| spelling | doaj.art-185a2778fd354bd9b2e62820a93b0f562024-01-02T12:05:08ZengBMJ Publishing GroupBMJ Open Respiratory Research2052-44392023-11-0110110.1136/bmjresp-2023-001726Inhaled corticosteroids and risk of lower respiratory tract infection with Moraxella catarrhalis in patients with chronic obstructive pulmonary diseasePradeesh Sivapalan0Josefin Eklöf1Jens-Ulrik Stæhr Jensen2Christian Østergaard3Jonas Bredtoft Boel4Ram Benny Dessau5Christian Kjer Heerfordt6Rikke Helin Johnsen7Section of Respiratory Medicine, Department of Medicine, Herlev-Gentofte Hospital, University of Copenhagen, Gentofte, DenmarkDepartment of Medicine, Section of Respiratory Medicine, Gentofte University Hospital, Hellerup, DenmarkDepartment of Clinical Medicine, University of Copenhagen, Kobenhavn, DenmarkDepartment of Clinical Microbiology, Hvidovre Hospital, University of Copenhagen, Hvidovre, DenmarkDepartment of Clinical Microbiology, Herlev-Gentofte Hospital, Herlev, DenmarkDepartment of Clinical Microbiology, Zealand University Hospital, University of Copenhagen, Slagelse, DenmarkSection of Respiratory Medicine, Department of Medicine, Herlev-Gentofte Hospital, University of Copenhagen, Gentofte, DenmarkSection of Respiratory Medicine, Department of Medicine, Herlev-Gentofte Hospital, University of Copenhagen, Gentofte, DenmarkBackground Use of inhaled corticosteroids (ICS) is common in patients with chronic obstructive pulmonary disease (COPD) and has been associated with an increased risk of pneumonia. Moraxella catarrhalis is one of the most common bacterial causes of infectious exacerbation in COPD. Currently, to our knowledge, no studies have investigated if ICS increases the risk of lower respiratory tract infection with M. catarrhalis in patients with COPD.Objective To investigate if accumulated ICS use in patients with COPD, is associated with a dose-dependent risk of infection with M. catarrhalis.Methods This observational cohort study included 18 870 persons with COPD who were registered in The Danish Register of COPD. Linkage to several nationwide registries was performed.Exposure to ICS was determined by identifying all prescriptions for ICS, redeemed within 365 days prior to study entry. Main outcome was a lower respiratory tract sample positive for M. catarrhalis. For the main analysis, a Cox multivariate regression model was used.We defined clinical infection as admission to hospital and/or a redeemed prescription for a relevant antibiotic, within 7 days prior to 14 days after the sample was obtained.Results We found an increased, dose-dependent, risk of a lower respiratory tract sample with M. catarrhalis among patients who used ICS, compared with non-users. For low and moderate doses of ICS HR was 1.65 (95% CI 1.19 to 2.30, p=0.003) and 1.82 (95% CI 1.32 to 2.51, p=0.0002), respectively. In the group of patients with highest ICS exposure, the HR of M. catarrhalis was 2.80 (95% CI 2.06 to 3.82, p<0.0001). Results remained stable in sensitivity analyses. 87% of patients fulfilled the criteria for clinical infection, and results remained unchanged in this population.Conclusion Our study shows a dose-dependent increased risk of infection with M. catarrhalis associated to ICS exposure.https://bmjopenrespres.bmj.com/content/10/1/e001726.full |
| spellingShingle | Pradeesh Sivapalan Josefin Eklöf Jens-Ulrik Stæhr Jensen Christian Østergaard Jonas Bredtoft Boel Ram Benny Dessau Christian Kjer Heerfordt Rikke Helin Johnsen Inhaled corticosteroids and risk of lower respiratory tract infection with Moraxella catarrhalis in patients with chronic obstructive pulmonary disease BMJ Open Respiratory Research |
| title | Inhaled corticosteroids and risk of lower respiratory tract infection with Moraxella catarrhalis in patients with chronic obstructive pulmonary disease |
| title_full | Inhaled corticosteroids and risk of lower respiratory tract infection with Moraxella catarrhalis in patients with chronic obstructive pulmonary disease |
| title_fullStr | Inhaled corticosteroids and risk of lower respiratory tract infection with Moraxella catarrhalis in patients with chronic obstructive pulmonary disease |
| title_full_unstemmed | Inhaled corticosteroids and risk of lower respiratory tract infection with Moraxella catarrhalis in patients with chronic obstructive pulmonary disease |
| title_short | Inhaled corticosteroids and risk of lower respiratory tract infection with Moraxella catarrhalis in patients with chronic obstructive pulmonary disease |
| title_sort | inhaled corticosteroids and risk of lower respiratory tract infection with moraxella catarrhalis in patients with chronic obstructive pulmonary disease |
| url | https://bmjopenrespres.bmj.com/content/10/1/e001726.full |
| work_keys_str_mv | AT pradeeshsivapalan inhaledcorticosteroidsandriskoflowerrespiratorytractinfectionwithmoraxellacatarrhalisinpatientswithchronicobstructivepulmonarydisease AT josefineklof inhaledcorticosteroidsandriskoflowerrespiratorytractinfectionwithmoraxellacatarrhalisinpatientswithchronicobstructivepulmonarydisease AT jensulrikstæhrjensen inhaledcorticosteroidsandriskoflowerrespiratorytractinfectionwithmoraxellacatarrhalisinpatientswithchronicobstructivepulmonarydisease AT christianøstergaard inhaledcorticosteroidsandriskoflowerrespiratorytractinfectionwithmoraxellacatarrhalisinpatientswithchronicobstructivepulmonarydisease AT jonasbredtoftboel inhaledcorticosteroidsandriskoflowerrespiratorytractinfectionwithmoraxellacatarrhalisinpatientswithchronicobstructivepulmonarydisease AT rambennydessau inhaledcorticosteroidsandriskoflowerrespiratorytractinfectionwithmoraxellacatarrhalisinpatientswithchronicobstructivepulmonarydisease AT christiankjerheerfordt inhaledcorticosteroidsandriskoflowerrespiratorytractinfectionwithmoraxellacatarrhalisinpatientswithchronicobstructivepulmonarydisease AT rikkehelinjohnsen inhaledcorticosteroidsandriskoflowerrespiratorytractinfectionwithmoraxellacatarrhalisinpatientswithchronicobstructivepulmonarydisease |