The Risk of Sepsis with Inhaled and Oral Corticosteroids in Patients with COPD

ABSTRACT

The use of oral and inhaled corticosteroids is associated with increases in the risk of infection, especially pneumonia. The risk of sepsis with corticosteroid treatment in patients with chronic obstructive pulmonary disease (COPD) has been little studied, however. We assessed whether the use of inhaled and oral corticosteroids in COPD is associated with an increase in the risk of sepsis. We carried out a retrospective cohort study using the administrative health databases of the province of Quebec, Canada, over the period 1990–2007. The cohort of patients with COPD included patients aged 55 years or older who used respiratory medications. A quasi-cohort analysis was used to estimate the rate ratio (RR) of sepsis in current users of inhaled corticosteroids and oral corticosteroids separately, after adjusting for differences in COPD disease severity and co-morbid conditions. The cohort included 163,514 patients treated for COPD, including 1,704 who were hospitalized for or died with sepsis during follow-up (incidence rate 1.94 per 1000 per year). The RR of sepsis associated with current use of inhaled corticosteroids was 0.98 (95%confidence interval [CI] 0.84–1.14). Current oral corticosteroid use was associated with a 66% increase in the risk of sepsis (RR 1.66; 95% CI: 1.35–2.05). The increase in risk remains for around 5 months after the oral corticosteroid exposure. Among patients treated for COPD, the risk of sepsis is not increased with inhaled corticosteroids, even at high doses, while the risk is increased with oral corticosteroids. This risk should be considered when treating exacerbations of COPD.

KEYWORDS:

• Adverse effects
• COPD therapy
• inhaled corticosteroids
• oral corticosteroids
• sepsis

Acknowledgments

The author Pierre Ernst is guarantor of the content of the manuscript. All authors contributed to the design of the study, carried out or verified the analyses and contributed to the drafting of the manuscript. The funding source had no input into the design or interpretation of the study. The authors would like to thank Melissa Dahan for help in preparing the manuscript.

Declaration of interest

Dr. Suissa has received funding for research, advisory board meetings or as speaker from AstraZeneca, Boehringer Ingelheim, Merck, and Novartis. Drs. Ernst, Brassard and Ms. Coulombe do not have any conflicts of interest to disclose.

Funding

This research was funded in part by a grant from the Canadian Institutes of Health Research (CIHR) and the Canadian Foundation for Innovation (CFI). Dr. Suissa is the recipient of the James McGill Professorship award.