title: Effect of outpatient therapy with inhaled corticosteroids on decreasing in-hospital mortality from pneumonia in patients with COPD.
abstract: OBJECTIVE
  Inhaled corticosteroids (ICS) and long-acting inhaled bronchodilators (IBD) are beneficial for the management of COPD. Although ICS has been reported to increase the risk of pneumonia in patients with COPD, it remains controversial whether it influences mortality. Using a Japanese national database, we examined the association between preadmission ICS therapy and in-hospital mortality from pneumonia in patients with COPD.
  
  
  METHODS
  We retrospectively collected data from 1,165 hospitals in Japan on patients with COPD who received outpatient inhalation therapy and were admitted with pneumonia. Patients were categorized into those who received ICS with IBD and those who received IBD alone. We performed multivariate logistic regression analysis to examine the association between outpatient ICS therapy and in-hospital mortality, adjusting for the patients' backgrounds.
  
  
  RESULTS
  Of the 7,033 eligible patients, the IBD alone group (n=3,331) was more likely to be older, have lower body mass index, poorer general conditions, and more severe pneumonia than the ICS with IBD group (n=3,702). In-hospital mortality was 13.2% and 8.1% in the IBD alone and the ICS with IBD groups, respectively. After adjustment for patients' backgrounds, the ICS with IBD group had significantly lower mortality than the IBD alone group (adjusted odds ratio, 0.80; 95% confidence interval, 0.68-0.94). Higher mortality was associated with older age, being male, lower body mass index, poorer general status, and more severe pneumonia.
  
  
  CONCLUSIONS
  Outpatient inhaled ICS and IBD therapy was significantly associated with lower mortality from pneumonia in patients with COPD than treatment with IBD alone.
authors.affiliation: Department of Respiratory Medicine, Graduate School of Medicine.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Yamauchi
authors.affiliation: Department of Clinical Epidemiology and Health Economics, School of Public Health.
authors.forename: Hideo
authors.initials: H
authors.lastname: Yasunaga
authors.affiliation: Department of Respiratory Medicine, Graduate School of Medicine.
authors.forename: Wakae
authors.initials: W
authors.lastname: Hasegawa
authors.affiliation: Department of Respiratory Medicine, Graduate School of Medicine.
authors.forename: Yukiyo
authors.initials: Y
authors.lastname: Sakamoto
authors.affiliation: Department of Respiratory Medicine, Graduate School of Medicine.
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Takeshima
authors.affiliation: Department of Respiratory Medicine, Graduate School of Medicine; Division for Health Service Promotion, The University of Tokyo.
authors.forename: Taisuke
authors.initials: T
authors.lastname: Jo
authors.affiliation: Department of Clinical Epidemiology and Health Economics, School of Public Health.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Matsui
authors.affiliation: Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan.
authors.forename: Kiyohide
authors.initials: K
authors.lastname: Fushimi
authors.affiliation: Department of Respiratory Medicine, Graduate School of Medicine.
authors.forename: Takahide
authors.initials: T
authors.lastname: Nagase
mesh_terms: D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage* / Q000009:adverse effects; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001993:Bronchodilator Agents / Q000008:administration & dosage* / Q000009:adverse effects; D016009:Chi-Square Distribution; D004359:Drug Therapy, Combination; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007564:Japan / Q000453:epidemiology; D016015:Logistic Models; D008168:Lung / Q000187:drug effects* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011014:Pneumonia / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D000893:Anti-Inflammatory Agents; D001993:Bronchodilator Agents
keywords: COPD; bronchodilators; in-hospital mortality; inhaled corticosteroids; pneumonia