RT Journal Article
SR Electronic
T1 Pneumonia risk in COPD patients receiving inhaled corticosteroids alone or in combination: TORCH study results
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP 641
OP 647
DO 10.1183/09031936.00193908
VO 34
IS 3
A1 C. Crim
A1 P. M. A. Calverley
A1 J. A. Anderson
A1 B. Celli
A1 G. T. Ferguson
A1 C. Jenkins
A1 P. W. Jones
A1 L. R. Willits
A1 J. C. Yates
A1 J. Vestbo
YR 2009
UL http://erj.ersjournals.com/content/34/3/641.abstract
AB Inhaled corticosteroids (ICS) are important in reducing exacerbation frequency associated with chronic obstructive pulmonary disease (COPD). However, little is known about the risk of associated infections. In a post hoc analysis of the TOwards a Revolution in COPD Health (TORCH) study, we analysed and identified potential risk factors for adverse event reports of pneumonia in this randomised, double-blind trial comparing twice-daily inhaled salmeterol (SAL) 50 μg, fluticasone propionate (FP) 500 μg, and the combination (SFC) with placebo in 6,184 patients with moderate-to-severe COPD over 3 yrs. Despite a higher withdrawal rate in the placebo arm, after adjusting for time on treatment, a greater rate of pneumonia was reported in the FP and SFC treatment arms (84 and 88 per 1,000 treatment-yrs, respectively) compared with SAL and placebo (52 and 52 per 1,000 treatment-yrs, respectively). Risk factors for pneumonia were age ≥55 yrs, forced expiratory volume in 1 s <50% predicted, COPD exacerbations in the year prior to the study, worse Medical Research Council dyspnoea scores and body mass index <25 kg·m−2. No increase in pneumonia deaths with SFC was observed; this could not be concluded for FP. Despite the benefits of ICS-containing regimens in COPD management, healthcare providers should remain vigilant regarding the possible development of pneumonia as a complication in COPD patients receiving such therapies.