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Pneumonia and pneumonia related mortality in patients with COPD treated with fixed combinations of inhaled corticosteroid and long acting beta(2) agonist : observational matched cohort study (PATHOS)

机译：吸入性糖皮质激素和长效β（2）激动剂固定联合治疗COPD患者的肺炎和与肺炎相关的死亡率：观察性队列研究（PATHOS）

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Objective To investigate the occurrence of pneumonia and pneumonia related events in patients with chronic obstructive pulmonary disease (COPD) treated with two different fixed combinations of inhaled corticosteroid/long acting beta(2) agonist. Design Observational retrospective pairwise cohort study matched (1:1) for propensity score. Setting Primary care medical records data linked to Swedish hospital, drug, and cause of death registry data for years 1999-2009. Participants Patients with COPD diagnosed by a physician and prescriptions of either budesonide/formoterol or fluticasone/salmeterol. Main outcome measures Yearly pneumonia event rates, admission to hospital related to pneumonia, and mortality. Results 9893 patients were eligible for matching (2738 in the fluticasone/salmeterol group; 7155 in the budesonide/formoterol group), yielding two matched cohorts of 2734 patients each. In these patients, 2115 (39%) had at least one recorded episode of pneumonia during the study period, with 2746 episodes recorded during 19 170 patient years of follow up. Compared with budesonide/formoterol, rate of pneumonia and admission to hospital were higher in patients treated with fluticasone/salmeterol:rate ratio 1.73 (95% confidence interval 1.57 to 1.90; P<0.001) and 1.74 (1.56 to 1.94; P<0.001), respectively. The pneumonia event rate per 100 patient years for fluticasone/salmeterol versus budesonide/formoterol was 11.0 (10.4 to 11.8) versus 6.4 (6.0 to 6.9) and the rate of admission to hospital was 7.4 (6.9 to 8.0) versus 4.3 (3.9 to 4.6). The mean duration of admissions related to pneumonia was similar for both groups, but mortality related to pneumonia was higher in the fluticasone/salmeterol group (97 deaths) than in the budesonide/formoterol group (52 deaths) (hazard ratio 1.76, 1.22 to 2.53; P=0.003). All cause mortality did not differ between the treatments (1.08, 0.93 to 1.14; P=0.59). Conclusions There is an intra-class difference between fixed combinations of inhaled corticosteroid/long acting beta(2) agonist with regard to the risk of pneumonia and pneumonia related events in the treatment of patients with COPD. Trial registration Clinical Trials.gov NCT01146392.
机译：目的研究两种不同的吸入性糖皮质激素/长效β（2）激动剂固定组合治疗慢性阻塞性肺疾病（COPD）患者的肺炎和肺炎相关事件的发生。设计观察性回顾性成对队列研究与倾向评分匹配（1：1）。设置与瑞典医院，毒品和死亡原因登记数据关联的1999-2009年的初级保健医疗记录数据。参加者经医生诊断患有COPD的患者，处方布地奈德/福莫特罗或氟替卡松/沙美特罗。主要结局指标每年的肺炎发生率，与肺炎有关的入院率和死亡率。结果有9 893例患者符合条件（氟替卡松/沙美特罗组为2738例，布地奈德/福莫特罗组为7155例），产生了两个匹配的队列，每组2734例。在这些患者中，有2115名（39％）在研究期间至少记录了一次肺炎发作，在19170个患者年的随访期间记录了2746次发作。与布地奈德/福莫特罗相比，氟替卡松/沙美特罗：比率为1.73（95％置信区间为1.57至1.90； P <0.001）和1.74（1.56至1.94； P <0.001）的患者，肺炎发生率和住院率更高。 ， 分别。氟替卡松/沙美特罗/布地奈德/福莫特罗每100患者年的肺炎发生率是11.0（10.4-11.8）对6.4（6.0-6.9），入院率是7.4（6.9-8.0）对4.3（3.9-4.6） ）。两组与肺炎相关的平均入院时间相似，但氟替卡松/沙美特罗组（97例死亡）的肺炎相关死亡率高于布地奈德/福莫特罗组（52例死亡）（危险比1.76、1.22至2.53 ; P = 0.003）。在所有治疗之间，所有原因的死亡率没有差异（1.08，0.93至1.14； P = 0.59）。结论吸入皮质类固醇/长效β（2）激动剂固定组合之间在治疗COPD患者中的肺炎和肺炎相关事件风险之间存在类内差异。试用注册Clinical Trials.gov NCT01146392。

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