title: Observational study of inhaled corticosteroids on outcomes for COPD patients with pneumonia.
abstract: BACKGROUND
  Treatment with inhaled corticosteroids (ICS) for those with chronic obstructive pulmonary disease (COPD) has been shown to be associated with an increased incidence of pneumonia. However, it is unclear if this is associated with increased mortality.
  
  
  OBJECTIVE
  The aim of this study was to examine the effects of prior use of ICS on clinical outcomes for patients with COPD hospitalized with pneumonia.
  
  
  METHODS
  We conducted a retrospective cohort study using the national administrative databases of the Department of Veterans Affairs. Eligible patients had a preexisting diagnosis of COPD, had a discharge diagnosis of pneumonia, and received treatment with one or more appropriate pulmonary medications before hospitalization. Outcomes included mortality, use of invasive mechanical ventilation, and vasopressor use.
  
  
  RESULTS
  There were 15,768 patients (8,271 with use of ICS and 7,497 with no use of ICS) with COPD who were hospitalized for pneumonia. There was also a significant difference for 90-day mortality (ICS 17.3% vs. no ICS 22.8%; P < 0.001). Multilevel regression analyses demonstrated that prior receipt of ICS was associated with decreased mortality at 30 days (odds ratio [OR] 0.80; 95% confidence interval [CI], 0.72-0.89) and 90 days (OR 0.78; 95% CI, 0.72-0.85), and decreased use of mechanical ventilation (OR 0.83; 95% CI, 0.72-0.94). There was no significant association between receipt of ICS and vasopressor use (OR 0.88; 95% CI, 0.74-1.04).
  
  
  CONCLUSIONS
  For patients with COPD, prior use of ICS is independently associated with decreased risk of short-term mortality and use of mechanical ventilation after hospitalization for pneumonia.
authors.affiliation: VERDICT/South Texas Veterans Health Care System, San Antonio, TX 78229, USA.
authors.forename: Dennis
authors.initials: D
authors.lastname: Chen
authors.forename: Marcos I
authors.initials: MI
authors.lastname: Restrepo
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Fine
authors.forename: Mary Jo V
authors.initials: MJ
authors.lastname: Pugh
authors.forename: Antonio
authors.initials: A
authors.lastname: Anzueto
authors.forename: Mark L
authors.initials: ML
authors.lastname: Metersky
authors.forename: Brandy
authors.initials: B
authors.lastname: Nakashima
authors.forename: Chester
authors.initials: C
authors.lastname: Good
authors.forename: Eric M
authors.initials: EM
authors.lastname: Mortensen
mesh_terms: D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D000368:Aged; D005260:Female; D006787:Hospitals, Veterans / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008297:Male; D019370:Observation; D011014:Pneumonia / Q000139:chemically induced* / Q000453:epidemiology / Q000401:mortality; D016016:Proportional Hazards Models; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy* / Q000401:mortality; D012044:Regression Analysis; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
chemical_list: D000305:Adrenal Cortex Hormones