Prehospital use of inhaled corticosteroids and point prevalence of pneumonia at the time of hospital admission: secondary analysis of a multicenter cohort study.
OBJECTIVE
To address clinical concern regarding the use of inhaled corticosteroids (ICSs) and the risk for pneumonia, particularly among patients with chronic obstructive pulmonary disease (COPD) and asthma.


METHODS
A multicentered prospective cohort of patients admitted to the hospital from March 1, 2009, through August 31, 2009, with pneumonia or another risk factor for acute respiratory distress syndrome was analyzed to determine the risk for pneumonia requiring hospitalization among patients taking ICSs. The adjusted risk (odds ratio [OR]) for developing pneumonia because of ICSs was determined in a multiple logistic regression model.


RESULTS
Of the 5584 patients in the cohort, 495 (9%) were taking ICSs and 1234 (22%) had pneumonia requiring hospitalization. In univariate analyses, pneumonia occurred in 222 (45%) of the patients on ICSs vs 1012 (20%) in those who were not (OR, 3.28; 95% CI, 2.71-3.96; P<.001). After adjusting in the logistic regression model, prehospital ICS use was not significantly associated with pneumonia in the whole cohort (OR, 1.20; 95% CI, 0.93-1.53; P=.162), among the subset of 589 patients with COPD (OR, 1.40; 95% CI, 0.95-2.09; P=.093), among the 440 patients with asthma (OR, 1.07; 95% CI, 0.61-1.87; P=.81), nor among the remaining 4629 patients without COPD or asthma (OR, 1.32; 95% CI, 0.88-1.97; P=.179).


CONCLUSIONS
When adjusted for multiple confounding variables, ICS use was not substantially associated with an increased risk for pneumonia requiring admission in our cohort.
Department of Critical Care, Mayo Clinic, Jacksonville, FL. Electronic address: festic.emir@mayo.edu.
Emir
E
Festic
Critical Care Research, Mayo Clinic, Jacksonville, FL.
Vikas
V
Bansal
Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.
Ognjen
O
Gajic
Department of Critical Care, Mayo Clinic, Jacksonville, FL.
Augustine S
AS
Lee
D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000009:adverse effects*; D000368:Aged; D001249:Asthma / Q000188:drug therapy; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000139:chemically induced* / Q000453:epidemiology*; D015995:Prevalence; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy; D012307:Risk Factors
D000305:Adrenal Cortex Hormones
ARDS; CAP; COPD; ICS; LIPS; Lung Injury Prediction Score; OR; acute respiratory distress syndrome; chronic obstructive pulmonary disease; community-acquired pneumonia; inhaled corticosteroid; odds ratio