Objectives: To examine whether these medications might be associated
with an excess risk of pneumonia.
Methods:We conducted a nested case-control study within a cohort
of patients with COPD from Quebec, Canada, over the period 1988–
2003, identified on the basis of administrative databases linking
hospitalization and drug-dispensing information. Each subject hospitalized
for pneumonia during follow-up (case subjects) was age
and time matched to four control subjects. The effect of the use
of inhaled corticosteroids was assessed by conditional logistic regression,
after adjusting for comorbidity and COPD severity.
Measurements and Main Results: The cohort included 175,906 patients
with COPD ofwhom 23,942 were hospitalized for pneumonia
during follow-up, for a rate of 1.9 per 100 per year, and matched
to 95,768 control subjects. The adjusted rate ratio of hospitalization
for pneumonia associated with current use of inhaled corticosteroids
was 1.70 (95% confidence interval [CI], 1.63–1.77) and 1.53
(95% CI, 1.30–1.80) for pneumonia hospitalization followed by
death within 30 days. The rate ratio of hospitalization for pneumonia
was greatest with the highest doses of inhaled corticosteroids,
equivalent to fluticasone at 1,000 g/day or more (rate ratio, 2.25;
95% CI, 2.07–2.44). All-cause mortality was similar for patients hospitalized
for pneumonia, whether or not they had received inhaled
corticosteroids in the recent past (7.4 and 8.2%, respectively).