Impact of inhaled corticosteroid use on outcome in COPD patients admitted with pneumonia

The aim of this study was to investigate whether inhaled corticosteroid (ICS) use affects outcome in patients with chronic obstructive pulmonary disease (COPD) admitted with community-acquired pneumonia (CAP). This was a prospective, observational study of patients with spirometry-confirmed COPD presenting with a primary diagnosis of CAP in Lothian, UK. Outcome measures were compared between ICS users and non-ICS users. Of 490 patients included in the study, 76.7% were classified as ICS users. ICS users had higher Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage compared with non-ICS users (mean +/- SD 3.2 +/- 0.8 versus 2.6 +/- 0.9; p<0.0001). There were no significant differences in pneumonia severity (mean +/- SD Pneumonia Severity Index (PSI) 4.2 +/- 0.8 versus 4.3 +/- 0.8 (p=0.3); mean +/- SD CURB-65 score 2.1 +/- 1.3 versus 2.3 +/- 1.3 (p=0.07)) or markers of systemic inflammation (median C-reactive protein 148 (interquartile range 58-268) mg.L(-1) versus 183 (IQR 85-302) mg.L(-1); p=0.08) between ICS users and non-ICS users. On multivariable analysis, after adjustment for COPD severity and PSI, ICS use was not independently associated with 30-day mortality (OR 1.71, 95% CI 0.75-3.90; p=0.2), 6-month mortality (OR 1.62, 95% CI 0.82-3.16; p=0.2), requirement for mechanical ventilation and/or inotropic support (OR 0.73, 95% CI 0.33-1.62; p=0.4) or development of complicated pneumonia (OR 0.71, 95% CI 0.25-1.99; p=0.5). Prior ICS use had no impact on outcome in patients with COPD admitted with CAP.