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Quantifying the real life risk profile of inhaled corticosteroids in COPD by record linkage analysis

BACKGROUND: Inhaled corticosteroids (ICS), especially when prescribed in combination with long-acting β(2) agonists have been shown to improve COPD outcomes. Although there is consistent evidence linking ICS with adverse effects such as pneumonia, the complete risk profile is unclear with conflictin...

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Autores principales: Flynn, Rob W, MacDonald, Thomas M, Hapca, Adrian, MacKenzie, Isla S, Schembri, Stuart
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4239312/
https://www.ncbi.nlm.nih.gov/pubmed/25407604
http://dx.doi.org/10.1186/s12931-014-0141-y
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author Flynn, Rob W
MacDonald, Thomas M
Hapca, Adrian
MacKenzie, Isla S
Schembri, Stuart
author_facet Flynn, Rob W
MacDonald, Thomas M
Hapca, Adrian
MacKenzie, Isla S
Schembri, Stuart
author_sort Flynn, Rob W
collection PubMed
description BACKGROUND: Inhaled corticosteroids (ICS), especially when prescribed in combination with long-acting β(2) agonists have been shown to improve COPD outcomes. Although there is consistent evidence linking ICS with adverse effects such as pneumonia, the complete risk profile is unclear with conflicting evidence on any association between ICS and the incidence or worsening of existing diabetes, cataracts and fractures. We investigated this using record linkage in a Dundee COPD population. METHODS: A record linkage study linking COPD and diabetes datasets with prescription, hospitalisation and mortality data via a unique Community Health Index (CHI) number. A Cox regression model was used to determine the association between ICS use and new diabetes or worsening of existing diabetes and hospitalisations for pneumonia, fractures or cataracts after adjusting for potential confounders. A time dependent analysis of exposure comparing time on versus off ICS was used to take into account patients changing their exposure status during follow-up and to prevent immortal time bias. RESULTS: 4305 subjects (3243 exposed to ICS, total of 17,229 person-years of exposure and 1062 non exposed, with a follow-up of 4,508 patient-years) were eligible for the study. There were 239 cases of new diabetes (DM) and 265 cases of worsening DM, 550 admissions for pneumonia, 288 hospitalisations for fracture and 505 cataract related admissions. The hazard ratio for the association between cumulative ICS and outcomes were 0.70 (0.43-1.12), 0.57 (0.24-1.37), 1.38 (1.09-1.74), 1.08 (0.73-1.59) and 1.42 (1.07-1.88) after multivariate analysis respectively. CONCLUSION: The use of ICS in our cohort was not associated with new onset of diabetes, worsening of existing diabetes or fracture hospitalisation. There was however an association with increased cataracts and pneumonia hospitalisations.
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spelling pubmed-42393122014-11-21 Quantifying the real life risk profile of inhaled corticosteroids in COPD by record linkage analysis Flynn, Rob W MacDonald, Thomas M Hapca, Adrian MacKenzie, Isla S Schembri, Stuart Respir Res Research BACKGROUND: Inhaled corticosteroids (ICS), especially when prescribed in combination with long-acting β(2) agonists have been shown to improve COPD outcomes. Although there is consistent evidence linking ICS with adverse effects such as pneumonia, the complete risk profile is unclear with conflicting evidence on any association between ICS and the incidence or worsening of existing diabetes, cataracts and fractures. We investigated this using record linkage in a Dundee COPD population. METHODS: A record linkage study linking COPD and diabetes datasets with prescription, hospitalisation and mortality data via a unique Community Health Index (CHI) number. A Cox regression model was used to determine the association between ICS use and new diabetes or worsening of existing diabetes and hospitalisations for pneumonia, fractures or cataracts after adjusting for potential confounders. A time dependent analysis of exposure comparing time on versus off ICS was used to take into account patients changing their exposure status during follow-up and to prevent immortal time bias. RESULTS: 4305 subjects (3243 exposed to ICS, total of 17,229 person-years of exposure and 1062 non exposed, with a follow-up of 4,508 patient-years) were eligible for the study. There were 239 cases of new diabetes (DM) and 265 cases of worsening DM, 550 admissions for pneumonia, 288 hospitalisations for fracture and 505 cataract related admissions. The hazard ratio for the association between cumulative ICS and outcomes were 0.70 (0.43-1.12), 0.57 (0.24-1.37), 1.38 (1.09-1.74), 1.08 (0.73-1.59) and 1.42 (1.07-1.88) after multivariate analysis respectively. CONCLUSION: The use of ICS in our cohort was not associated with new onset of diabetes, worsening of existing diabetes or fracture hospitalisation. There was however an association with increased cataracts and pneumonia hospitalisations. BioMed Central 2014-11-19 2014 /pmc/articles/PMC4239312/ /pubmed/25407604 http://dx.doi.org/10.1186/s12931-014-0141-y Text en © Flynn et al.; licensee BioMed Central Ltd. 2014 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research
Flynn, Rob W
MacDonald, Thomas M
Hapca, Adrian
MacKenzie, Isla S
Schembri, Stuart
Quantifying the real life risk profile of inhaled corticosteroids in COPD by record linkage analysis
title Quantifying the real life risk profile of inhaled corticosteroids in COPD by record linkage analysis
title_full Quantifying the real life risk profile of inhaled corticosteroids in COPD by record linkage analysis
title_fullStr Quantifying the real life risk profile of inhaled corticosteroids in COPD by record linkage analysis
title_full_unstemmed Quantifying the real life risk profile of inhaled corticosteroids in COPD by record linkage analysis
title_short Quantifying the real life risk profile of inhaled corticosteroids in COPD by record linkage analysis
title_sort quantifying the real life risk profile of inhaled corticosteroids in copd by record linkage analysis
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4239312/
https://www.ncbi.nlm.nih.gov/pubmed/25407604
http://dx.doi.org/10.1186/s12931-014-0141-y
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