Background
Methods
Study design
Study subjects
Outcomes
Statistical analysis
Results
Patient demographics
Variable | COPD with lung function data (N = 6623) | Reference, without ICS usage (N = 48,566) | p-value |
---|---|---|---|
Age, mean years ± SD | 65.9 ± 10.1 | 64.5 ± 10.5 | < 0.0001 |
Female, n (%) | 3688 (55.7) | 26,792 (55.2) | 0.4699 |
Comorbidities below, n (%) | |||
Asthma, J45 | 974 (14.7) | 0 | < 0.0001 |
Cardiovascular disease, I00-I99 | 2514 (38.0) | 9932 (20.4) | < 0.0001 |
Hypertensive diseases, I10-I15 | 1707 (25.8) | 5941 (12.2) | < 0.0001 |
Ischemic heart diseases, I20-I25 | 584 (8.8) | 2052 (4.2) | < 0.0001 |
Cerebrovascular diseases, I60-I69 | 213 (3.2) | 1182 (2.4) | 0.0001 |
Diabetes Type I, E10 | 83 (1.2) | 757 (1.6) | 0.0568 |
Diabetes Type II, E11 + E13 | 418 (6.3) | 2049 (4.2) | < 0.0001 |
Hyperlipidemia, E78.5 | 161 (2.4) | 502 (1.0) | < 0.0001 |
Depression, F32 + F33 | 456 (6.9) | 873 (1.8) | < 0.0001 |
Osteoporosis, M80 + M81 | 139 (2.1) | 402 (0.8) | < 0.0001 |
Fractures, S2 | 356 (5.4) | 1968 (4.0) | < 0.0001 |
Charlson Comorbidity Index value, mean ± SD | 1.55 ± 0.8 | 1.26 ± 0.6 | < 0.0001 |
Health care utilization | |||
Number of outpatient hospital visits/year in 2 years before index date, mean ± SD | 1.53 ± 2.4 | 1.60 ± 3.7 | 0.1980 |
Number of contacts to primary care/year in 2 years before index date, mean ± SD | 12.0 ± 16.0 | 4.14 ± 13.6 | < 0.0001 |
ICS use, n (%) | |||
No ICS | 3385 (51.1) | NA | |
Low dose ICSb | 2189 (33.0) | NA | |
High dose ICSc | 1049 (15.8) | NA |
Medication use
Variable | COPD patients with lung function data (N = 6623)a |
---|---|
Types of ICS, n (%) | |
Budesonide | 2317 (71.5) |
Fluticasone propionate | 236 (7.3) |
Budesonide/fluticasone propionateb | 655 (20.2) |
Other | 30 (0.9) |
Pneumonia risk
FEV1 < 50% Hazard ratio (95% CI) (N = 2730) | FEV1 ≥ 50% Hazard ratio (95% CI) (N = 5547) | |
---|---|---|
Agea | 1.04 (1.03–1.04) | 1.04 (1.04–1.04) |
Malesb | 1.28 (1.20–1.36) | 1.26 (1.19–1.34) |
COPD + asthma compared with referencec | ||
Reference | 1 | 1 |
No ICS | 3.06 (2.35–3.97) | 4.61 (3.70–5.75) |
Low ICSd | 6.61 (5.43–8.05) | 5.31 (4.57–6.18) |
High ICSe | 6.40 (5.30–7.72) | 5.40 (4.56–6.38) |
‘COPD without asthma’ compared with referencec | ||
Reference | 1 | 1 |
No ICS | 4.35 (3.79–4.99) | 4.01 (3.58–4.49) |
Low ICS | 6.15 (5.23–7.24) | 4.52 (3.91–5.23) |
High ICS | 4.91 (3.82–6.31) | 4.62 (3.45–6.18) |
‘COPD without asthma’: ICS use compared with no ICS use in the COPD population | ||
No ICS | 1 | 1 |
Low ICS | 1.06 (0.91–1.25) | 1.20 (1.05–1.38) |
High ICS | 0.98 (0.81–1.17) | 1.31 (1.10–1.56) |
ICS use
Presence of asthma
COPD without asthma Hazard ratio (95% CI) (N = 4299) | COPD with asthma Hazard ratio (95% CI) (N = 2324) | |
---|---|---|
Agea | 1.05 (1.05–1.06) | 1.05 (1.05–1.05) |
Malesb | 1.19 (1.12–1.27) | 1.21 (1.14–1.29) |
Reference populationc | 1 | 1 |
COPD with no ICS versus ref | 3.35 (2.82–3.97) | 5.00 (4.56–5.48) |
COPD with low ICSd versus ref | 7.86 (6.96–8.89) | 6.36 (5.69–7.11) |
COPD with high ICSe versus ref | 7.08 (6.22–8.04) | 4.56 (3.76–5.53) |
Within the COPD group: ICS use compared with no ICS use | ||
No ICS | 1 | 1 |
Low ICS | 1.29 (1.05–1.58) | 1.46 (1.28–1.67) |
High ICS | 1.59 (1.30–1.96) | 1.69 (1.37–2.07) |
Independent variables associated with pneumonia
Hazard ratio (95% CI) | p-value | |
---|---|---|
Agea | 1.01 (1.00–1.01) | 0.06 |
Maleb | 1.13 (1.03–1.25) | 0.01 |
No ICS | 1 | |
Low ICSc | 1.23 (1.10–1.38) | 0.0003 |
High ICSd | 1.41 (1.23–1.62) | < 0.0001 |
FEV1 < 50% | 1.33 (1.21–1.47) | |
FEV1 ≥ 50% | 1 | |
No asthma | 1 | |
Asthma | 1.13 (1.01–1.27) | 0.0310 |
Charlson Comorbidity indexe | 1.02 (0.96–1.09) | 0.4621 |