Inhaled corticosteroid related pneumonia in real world among the patients with asthma and COPD

Background: To investigate the occurrence of pneumonia in the real world among patients with chronic obstructive pulmonary disease (COPD), asthma, or asthma-COPD overlap syndrome (ACOS) treated with two different inhaled corticosteroids (ICS), budesonide vs fluticasone. Methods: National registry data were collected from the Korean National Health Insurance Research Database, comprising 1,025,340 random subjects who were selected from 46,605,433 Korean residents in 2002. Patients with asthma or COPD who used budesonide or fluticasone for the first time since 2003 were enrolled. Pneumonia and ICS-related pneumonia (pneumonia with history of ICS usage within 3 months) were counted. Pneumonia was identified if ICD-10 diagnosis and antibiotics were prescribed within 2 day. Results: A total of 15,476 patients were enrolled and there were 2,707 patients with pneumonia during follow-up periods. Univariate analysis showed that pneumonia were more frequent in patients with older age, higher daily ICS dose, more severe asthma/COPD in terms of admission and emergency room visits, and fluticasone usage. However there were no differences in pneumonia between fluticasone and budesonide after adjustments for daily dose of ICS. Among 2,707 patients with pneumonia, there were 868 patients (30%) with ICS-related pneumonia. But among them, 209 (209/868, 14.3%) patients started ICS within 1 week before pneumonia and ICS-related pneumonia were more prevalent in patients with older age and higher severity of asthma/COPD. Conclusion: Pneumonia and ICS-related pneumonia were prevalent in ICS users for asthma and COPD who were older age and showed higher severity.