Incidence of oral thrush in patients with COPD prescribed inhaled corticosteroids: Effect of drug, dose, and device.
Little information is available on real-life occurrence of oral thrush in COPD patients treated with ICS. We investigated oral thrush incidence in COPD patients prescribed FDC ICS/LABA therapies and assessed whether it is modulated by the ICS type, dose, and delivery device.



We conducted a historical, observational, matched cohort study (one baseline year before and one outcome year after initiation of therapy) using data from the UK Optimum Patient Care Research Database. We assessed oral thrush incidence in patients initiating long-acting bronchodilators or FDC ICS/LABA therapy. We then compared different combination therapies (budesonide/formoterol fumarate dihydrate [BUD/FOR] and fluticasone propionate/salmeterol xinafoate [FP/SAL]) and devices (DPI and pMDI).



Patients prescribed FDC ICS/LABA had significantly greater odds of experiencing oral thrush than those prescribed long-acting bronchodilators alone (adjusted OR 2.18 [95% CI 1.84-2.59]). Significantly fewer patients prescribed BUD/FOR DPI developed oral thrush compared with FP/SAL DPI (OR 0.77 [0.63-0.94]) when allowing for differences in prescribed doses between the drugs. A significantly smaller proportion of patients developed oral thrush in the FP/SAL pMDI arm than in the FP/SAL DPI arm (OR 0.67 [0.55-0.82]). Additionally, in the FP/SAL cohort (both DPI and pMDI), increased risk of oral thrush was significantly associated with high ICS daily dose (OR 1.97 [1.22-3.17] vs low daily dose).



ICS use increases oral thrush incidence in COPD and this effect is dose-dependent for FP/SAL therapies. Of the therapies assessed, FP/SAL pMDI and BUD/FOR DPI may be more protective against oral thrush.
Radboud University Medical Center, Nijmegen, The Netherlands.
P N Richard
PNR
Dekhuijzen
Cambridge Research Support Ltd, Cambridge, UK; Observational and Pragmatic Research Institute Pte Ltd, Singapore.
Maria
M
Batsiou
Lung Medicine and Allergology, Department of Clinical Sciences, Lund University, Lund, Sweden.
Leif
L
Bjermer
Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia.
Sinthia
S
Bosnic-Anticevich
Observational and Pragmatic Research Institute Pte Ltd, Singapore; Faculty of Health and Human Sciences, Plymouth University, Plymouth, UK.
Henry
H
Chrystyn
Respiratory Diseases Unit, Department of Medical Sciences, University of Ferrara, Ferrara, Italy.
Alberto
A
Papi
Universitat de Barcelona, Hospital Clínic-IDIBAPS, Barcelona, Spain.
Roberto
R
Rodríguez-Roisin
Education for Health, Warwick, UK.
Monica
M
Fletcher
Observational and Pragmatic Research Institute Pte Ltd, Singapore.
Lucy
L
Wood
Cambridge Research Support Ltd, Cambridge, UK; Observational and Pragmatic Research Institute Pte Ltd, Singapore.
Alessandra
A
Cifra
Instituto de Investigación Hospital Universitario de la Princesa (IISP), Universidad Autónoma de Madrid, Madrid, Spain.
Joan B
JB
Soriano
Observational and Pragmatic Research Institute Pte Ltd, Singapore; Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK. Electronic address: dprice@opri.sg.
David B
DB
Price
D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D058666:Adrenergic beta-2 Receptor Agonists / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D000368:Aged; D002176:Candida albicans / Q000187:drug effects; D002180:Candidiasis, Oral / Q000139:chemically induced* / Q000453:epidemiology; D015331:Cohort Studies; D004338:Drug Combinations; D058995:Dry Powder Inhalers / Q000009:adverse effects / Q000592:standards; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D036501:Metered Dose Inhalers / Q000009:adverse effects / Q000592:standards; D018727:Muscarinic Antagonists / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D017063:Outcome Assessment, Health Care; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000188:drug therapy*; D006113:United Kingdom / Q000453:epidemiology
D000305:Adrenal Cortex Hormones; D058666:Adrenergic beta-2 Receptor Agonists; D004338:Drug Combinations; D018727:Muscarinic Antagonists
Chronic obstructive pulmonary disease; Dry powder inhaler; Inhaled corticosteroid; Oral candidiasis; Pressurised metered-dose inhaler; Spacer