Extract
The safety and risk–benefit profiles associated with different types and dosages of inhaled corticosteroids (ICS) in older individuals with asthma and COPD remain unknown [1, 2]. Limited evidence suggests that adults with asthma prescribed medium or high ICS doses are at risk of clinically important systemic side-effects that do not plateau with higher doses as efficacy outcomes do [3]. Older patients with COPD have been shown to have increased risk of pneumonia with both budesonide and fluticasone [4]; however, the risk seems greater with the latter [2, 4–6].
Abstract
This study suggested a less favourable safety-effectiveness profile for fluticasone compared to budesonide and other ICS in elderly individuals with asthma, COPD or both. Higher ICS dose was not associated with improved effectiveness in these populations. https://bit.ly/3iNdjkQ
Acknowledgements
The severity of comorbidities at baseline was approximated using an aggregated score, the Johns Hopkins’ Aggregated Diagnosis Groups categories (The Johns Hopkins ACG® System, Version 10). We thank IMS Brogan Inc. for the use of their Drug Information Database. We acknowledge using data from Service Ontario and Immigration, Refugees and Citizenship Canada.
Footnotes
Data availability: In Ontario (Canada), details on virtually all physician and hospital services are captured in health administrative databases housed at ICES (formerly known as the Institute for Clinical Evaluative Sciences). For the current study, these databases were linked on an individual level using unique encoded identifiers. The resulting dataset is held securely in coded form at the ICES. While data sharing agreements prohibit ICES from making the data set publicly available, access may be granted to those who meet pre-specified criteria for confidential access, available at www.ices.on.ca/DAS. A full data set creation plan for the study is available from the authors upon request.
Author contributions: All co-authors were involved in the following: study conception and design, interpretation of data, revising the manuscript critically for the accuracy and important intellectual content, and final approval of the version to be published. T. Kendzerska additionally was involved in the following: literature search, obtaining administrative data, analyses of data and drafting of the manuscript. A.S. Gershon additionally was involved in ethics board application, obtaining administrative data, analyses of data and drafting of the manuscript. A.S. Gershon and T. Kendzerska had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Conflict of interest: T. Kendzerska reports grants from Canadian Respiratory Research Network, during the conduct of the study.
Conflict of interest: S.D. Aaron has nothing to disclose.
Conflict of interest: T. To has nothing to disclose.
Conflict of interest: C. Licskai has nothing to disclose.
Conflict of interest: M.B. Stanbrook has nothing to disclose.
Conflict of interest: M-E. Hogan has nothing to disclose.
Conflict of interest: W.C. Tan has nothing to disclose.
Conflict of interest: J. Bourbeau has nothing to disclose.
Conflict of interest: A.S. Gershon reports grants from Canadian Respiratory Research Network and Health Systems Research Fund Capacity Grant, Government of Ontario, during the conduct of the study.
Support statement: This project is supported by the Health Systems Research Fund Capacity Grant, Government of Ontario, and Canadian Respiratory Research Network (CRRN). The CRRN is supported by grants from the Canadian Institutes of Health Research (CIHR) - Institute of Circulatory and Respiratory Health; Canadian Lung Association (CLA)/Canadian Thoracic Society (CTS); British Columbia Lung Association; and Industry Partners Boehringer Ingelheim Canada Ltd, AstraZeneca Canada Inc., and Novartis Canada Ltd. This study was also supported by ICES (formerly known as the Institute for Clinical Evaluative Sciences), which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC). No endorsement by ICES or the Ontario MOHLTC is intended or should be inferred. Parts of this material are based on data and information compiled and provided by the Canadian Institute for Health Information (CIHI). None of the sources had a role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or in the decision to submit the report for publication. Funding information for this article has been deposited with the Crossref Funder Registry.
- Received April 13, 2020.
- Accepted July 5, 2020.
- Copyright ©ERS 2021
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