Inhaled corticosteriod use and the risk of pneumonia and COPD exacerbations in the UPLIFT study

Morjaria, Jaymin B.; Morice, Alyn H.; Morice, Alyn; Rigby, Alan; Morjaria, Jaymin

Abstract

Rationale Unlike many other COPD studies, the 4-year UPLIFT trial permitted inhaled corticosteroid (ICS) use during run-in and treatment phases. This provided the opportunity to prospectively observe the continuing effects of ICS on respiratory events in closely observed COPD population. Objectives We aimed to determine rate and number of episodes of pneumonia and exacerbations of COPD in patients entering the study on no ICS, fluticasone proprionate (FP), and other ICS. Methods The UPLIFT dataset was examined retrospectively, and patients were divided into three groups based on their medications at entry: no ICS, FP and other ICS. Poisson regression was used to compare the frequency of respiratory adverse events. Measurements and main results At entry, the groups were well matched apart from a higher FEV1% predicted (38 vs. 41%; ICS vs. no ICS, respectively) and prevalence of current smoking (26 vs. 36%; ICS vs. no ICS, respectively). Incidence rates of pneumonia were significantly higher in patients taking ICS compared to no ICS (0.068 vs. 0.056 respectively; p = 0.012). When the FP group was compared to the other ICS, the event rate was even higher (0.077 vs. 0.058, respectively; p < 0.001). COPD exacerbations were more frequent in patients taking ICS, with significantly greater rate in the FP group compared to that seen with other ICS (0.93 vs. 0.84 respectively; p = 0.013). Conclusions ICS use was associated an increase in respiratory adverse event rates, but whether this was due to more severe illness at entry is unknown. In subgroup analysis, the excess of morbidity in the ICS group appeared to be mainly associated with those receiving FP at randomisation.

Citation

Morjaria, J. B., Morice, A. H., Morice, A., Rigby, A., & Morjaria, J. (2017). Inhaled corticosteriod use and the risk of pneumonia and COPD exacerbations in the UPLIFT study. Lung, 195(3), 281-288. https://doi.org/10.1007/s00408-017-9990-8

• Acceptance Date: Feb 20, 2017
• Online Publication Date: Mar 3, 2017
• Publication Date: Jun 1, 2017
• Deposit Date: Mar 21, 2017
• Publicly Available Date: Mar 21, 2017
• Journal: Lung
• Print ISSN: 0341-2040
• Publisher: Springer Verlag
• Peer Reviewed: Peer Reviewed
• Volume: 195
• Issue: 3
• Pages: 281-288
• DOI: https://doi.org/10.1007/s00408-017-9990-8
• Keywords: Fluticasone, Inhaled corticosteriods, Tiotropium, UPLIFT, Pneumonia, COPD
• Public URL: https://hull-repository.worktribe.com/output/449807
• Publisher URL: http://link.springer.com/article/10.1007%2Fs00408-017-9990-8
• Additional Information: Copy of article first published in: Morjaria, J.B., Rigby, A. & Morice, A.H. Lung (2017). doi:10.1007/s00408-017-9990-8. The final publication is available at Springer via http://dx.doi.org/10.1007/s00408-017-9990-8
• Contract Date: Mar 21, 2017