title: Relationship between the use of inhaled steroids for chronic respiratory diseases and early outcomes in community-acquired pneumonia.
abstract: BACKGROUND
  The role of inhaled steroids in patients with chronic respiratory diseases is a matter of debate due to the potential effect on the development and prognosis of community-acquired pneumonia (CAP). We assessed whether treatment with inhaled steroids in patients with chronic bronchitis, COPD or asthma and CAP may affect early outcome of the acute pneumonic episode.
  
  
  METHODS
  Over 1-year period, all population-based cases of CAP in patients with chronic bronchitis, COPD or asthma were registered. Use of inhaled steroids were registered and patients were followed up to 30 days after diagnosis to assess severity of CAP and clinical course (hospital admission, ICU admission and mortality).
  
  
  RESULTS
  Of 473 patients who fulfilled the selection criteria, inhaled steroids were regularly used by 109 (23%). In the overall sample, inhaled steroids were associated with a higher risk of hospitalization (OR=1.96, p = 0.002) in the bivariate analysis, but this effect disappeared after adjusting by other severity-related factors (adjusted OR=1.08, p=0.787). This effect on hospitalization also disappeared when considering only patients with asthma (OR=1.38, p=0.542), with COPD alone (OR=4.68, p=0.194), but a protective effect was observed in CB patients (OR=0.15, p=0.027). Inhaled steroids showed no association with ICU admission, days to clinical recovery and mortality in the overall sample and in any disease subgroup.
  
  
  CONCLUSIONS
  Treatment with inhaled steroids is not a prognostic factor in COPD and asthmatic patients with CAP, but could prevent hospitalization for CAP in patients with clinical criteria of chronic bronchitis.
authors.affiliation: Critical Care Unit, Universitat Autònoma de Barcelona, CIBERES, Barcelona, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Almirall
authors.forename: Ignasi
authors.initials: I
authors.lastname: Bolíbar
authors.forename: Mateu
authors.initials: M
authors.lastname: Serra-Prat
authors.forename: Elisabet
authors.initials: E
authors.lastname: Palomera
authors.forename: Jordi
authors.initials: J
authors.lastname: Roig
authors.forename: Imma
authors.initials: I
authors.lastname: Hospital
authors.forename: Eugenia
authors.initials: E
authors.lastname: Carandell
authors.forename: Mercè
authors.initials: M
authors.lastname: Agustí
authors.forename: Pilar
authors.initials: P
authors.lastname: Ayuso
authors.forename: Andreu
authors.initials: A
authors.lastname: Estela
authors.forename: Antoni
authors.initials: A
authors.lastname: Torres
mesh_terms: D000280:Administration, Inhalation; D001249:Asthma / Q000150:complications / Q000188:drug therapy*; D029481:Bronchitis, Chronic / Q000150:complications / Q000188:drug therapy*; D017714:Community-Acquired Infections / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D011014:Pneumonia / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D011379:Prognosis; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000188:drug therapy*; D013256:Steroids / Q000008:administration & dosage / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D013256:Steroids
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