Abstract | OBJECTIVES: Inhaled corticosteroids (ICS) are widely used in patients with chronic obstructive pulmonary disease ( COPD). However, ICS are associated with an increased risk of adverse effects.We aimed to determine whether an association between a lower respiratory tract culture with Stenotrophomonas maltophilia and increasing ICS dosing in patients with COPD exists. DESIGN: An observational cohort study of outpatients with COPD in Denmark between 2010 and 2018.ICS exposure was categorised into four groups based on average daily consumption 1 year prior to inclusion: no use, low ICS dose (≤400 µg), moderate ICS dose (400-800 µg) and high ICS dose (>800 µg). Dose-response relationship was investigated by a multivariable Cox proportional hazards regression. RESULTS: Of the total 22 689 patients, 459 had lower respiratory tract cultures positive for S. maltophilia. The HR of S. maltophilia increased with increasing daily ICS dose: low ICS dose HR 2.6 (95% CI 1.6 to 4.0), moderate ICS dose HR 3.0 (95% CI 1.9 to 4.6) and high ICS dose HR 5.7 (95% CI 3.8 to 8.5). CONCLUSIONS: We found that ICS was associated with a high, dose-dependent increased hazard of S. maltophilia in outpatients with COPD. High dose users had a nearly six times increased hazard compared with non-users of ICS. When appropriate, attempts at de-escalating ICS treatment should be made.
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Authors | Christian Rønn, Peter Kamstrup, Christian Kjer Heerfordt, Pradeesh Sivapalan, Josefin Eklöf, Jonas Bredtoft Boel, Christian Ostergaard, Ram Benny Dessau, Mia Moberg, Julie Janner, Charlotte Suppli Ulrik, Jens-Ulrik Stæhr Jensen |
Journal | BMJ open respiratory research
(BMJ Open Respir Res)
Vol. 11
Issue 1
(Mar 09 2024)
ISSN: 2052-4439 [Electronic] England |
PMID | 38460975
(Publication Type: Observational Study, Journal Article)
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Copyright | © Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. |
Chemical References |
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Topics |
- Humans
- Stenotrophomonas maltophilia
- Retrospective Studies
- Outpatients
- Administration, Inhalation
- Pulmonary Disease, Chronic Obstructive
- Adrenal Cortex Hormones
- Cohort Studies
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