• Rosa Morros, Cristina Vedia, Maria Giner-Soriano, Aina Casellas, Ester Amado, Jose Miguel Baena, and en representación de los investigadores del proyecto PNEUMOCORT.
• Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, España; Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, España; Institut Català de la Salut, Generalitat de Catalunya, Barcelona, España.
• Aten Primaria. 2019 Jun 1; 51 (6): 333-340.

ObjectivesTo analyse the risk of pneumonia and/or exacerbations in patients with chronic obstructive pulmonary disease (COPD) who receive treatment with inhaled corticosteroids (CI), in comparison with those who are not treated with inhaled corticosteroids (NCI). To estimate the risk of pneumonia according to CI dose.DesignPopulation-based cohort study.SettingPrimary Healthcare. Institut Català de la Salut.ParticipantsPatients ≥45 years-old diagnosed with COPD between 2007 and 2009 in the Information System for Research in Primary Care (SIDIAP).InterventionTwo cohorts; patients initiating CI and patients initiating bronchodilators after COPD diagnosis.Main MeasurementsDemographics, smoking, medical history, pneumonias, exacerbations, vaccinations, and drug therapy.ResultsA total of 3,837 patients were included, 58% in the CI and 42% in the NCI group. Higher incidence rates of pneumonia and exacerbations were detected in the CI group compared with the NCI (2.18 vs. 1.37). The risk of pneumonia and severe exacerbations was not significantly different between groups, HR; 1.17 (95% CI; 0.87-1.56) and 1.06 (95% CI; 0.87-1.31), respectively. Patients in the CI group had a higher risk of mild exacerbations, HR; 1.28 (95% CI; 1.10-1.50). Variables associated with a higher risk of pneumonia were age, diabetes, previous pneumonias and bronchitis, very severe COPD, treatment with low doses of β2-adrenergic or anticholinergic agents, and previous treatment with oral corticosteroids.ConclusionsThere were no differences between cohorts in the risk of pneumonia and severe exacerbations. The risk of mild exacerbations was higher in the CI group. Pneumonias and severe exacerbations were more frequent in patients with severe COPD and in patients receiving high doses of CI.Copyright © 2018 The Authors. Publicado por Elsevier España, S.L.U. All rights reserved.

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