RT Journal Article
SR Electronic
T1 Adverse Outcomes Associated With Inhaled Corticosteroid Use in Individuals With Chronic Obstructive Pulmonary Disease
JF The Annals of Family Medicine
JO Ann Fam Med
FD American Academy of Family Physicians
SP 127
OP 135
DO 10.1370/afm.240030
VO 23
IS 2
A1 Pace, Wilson D.
A1 Callen, Elisabeth
A1 Gaona-Villarreal, Gabriela
A1 Shaikh, Asif
A1 Yawn, Barbara P.
YR 2025
UL http://www.annfammed.org/content/23/2/127.abstract
AB PURPOSE We aimed to assess long-term inhaled corticosteroid (ICS) risks in chronic obstructive pulmonary disease (COPD) management.METHODS We extracted electronic health record data for individuals aged >45 years with COPD from a data repository. The prevalent cohort required a diagnosis of COPD any time during the observation period, and the inception cohort required a diagnosis of COPD made after entry into the database. A composite outcome of any new diagnosis of type 2 diabetes, cataracts, pneumonia, osteoporosis, or nontraumatic fracture; and recurrent event outcomes of repeated pneumonia or nontraumatic fracture were compared for long-term (>24 months) vs short-term (<4 months) ICS exposure.RESULTS We assessed outcomes for 318,385 and 209,062 individuals in the prevalent and inception cohorts, respectively. The composite dichotomous outcome was significantly greater for long-term vs short-term ICS use for the prevalent (hazard ratio [HR] = 2.65; 95% CI, 2.62-2.68; P <.001) and inception (HR = 2.60; 95% CI, 2.56-2.64; P <.001) cohorts. For the inception cohort, the absolute risk difference of the composite outcome was 20.26% (29.41% minus 9.15%), with a number needed to harm of 5. Hazard ratios were significantly increased in the prevalent and inception cohorts for recurrent pneumonia (HR = 2.88; 95% CI, 2.62-3.16; P <.001 and HR = 2.85; 95% CI, 2.53-3.22; P <.001, respectively) and recurrent fracture (HR = 1.77; 95% CI, 1.42-2.21; P <.001 and HR = 1.57; 95% CI, 1.20-2.06; P <.001).CONCLUSIONS Long-term ICS use for COPD is associated with significantly greater rates of the composite outcome of type 2 diabetes, cataracts, pneumonia, osteoporosis, and nontraumatic fracture; recurrent pneumonia; and recurrent fracture.