Influence of previous use of inhaled corticoids on the development of pleural effusion in community-acquired pneumonia.

Abstract

RATIONALE:

Previous use of inhaled corticosteroids (ICS) in patients with chronic obstructive pulmonary disease has been associated with increased risk of community-acquired pneumonia. However, ICS have been associated with fewer pneumonia complications and decreased risk of pneumonia-related mortality.

OBJECTIVES:

The objective of the study was to assess the influence of previous use of ICS on the incidence of parapneumonic effusion in patients with different baseline respiratory disorders.

METHODS:

We conducted a single-center cohort study of 3,612 consecutively collected patients diagnosed with community-acquired pneumonia. We assessed clinical, radiographic, and pleural-fluid chemistry and microbiologic variables. Patients were classified according to whether or not they received prior ICS treatment.

MEASUREMENTS AND MAIN RESULTS:

A total of 633 patients (17%) were treated with corticosteroids before the diagnosis of pneumonia (chronic obstructive pulmonary disease, 54%; asthma, 13%). Incidence of parapneumonic effusion was lower in patients with ICS use compared with non-ICS patients (5% vs. 12%; P < 0.001). After matching according to propensity scores (n = 640), prior treatment with corticosteroids was still significantly associated with a lower incidence of parapneumonic effusion (odds ratio, 0.40; 95% confidence interval, 0.23-0.69; P = 0.001) compared with patients without ICS treatment. Prior ICS treatment was associated with higher levels of glucose (P = 0.003) and pH (P = 0.02), and lower levels of protein (P = 0.01) and lactic acid dehydrogenase (P = 0.007) in the pleural fluid.

CONCLUSIONS:

Prior treatment with ICS in a population of patients with different respiratory chronic disorders who develop pneumonia is associated with lower incidence of parapneumonic effusion.

• Authors: Jacobo Sellares, Alejandra López-Giraldo, Carmen Lucena, Catia Cilloniz, Rosanel Amaro, Eva Polverino, Miquel Ferrer, Rosario Menéndez, Josep Mensa, Antoni Torres
• Journal: American journal of respiratory and critical care medicine (Am J Respir Crit Care Med) Vol. 187 Issue 11 Pg. 1241-8 (Jun 01 2013) ISSN: 1535-4970 [Electronic] United States
• PMID: 23590264 (Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Glucocorticoids

Topics

• Administration, Inhalation
• Aged
• Asthma (drug therapy)
• Community-Acquired Infections (epidemiology, etiology)
• Female
• Follow-Up Studies
• Glucocorticoids (administration & dosage, adverse effects)
• Humans
• Incidence
• Male
• Pleural Effusion (chemically induced, epidemiology)
• Pneumonia (epidemiology, etiology)
• Prospective Studies
• Pulmonary Disease, Chronic Obstructive (drug therapy)
• Risk Factors
• Spain (epidemiology)