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Inhaled corticosteroids and systemic inflammatory response in community‐acquired pneumonia: A prospective clinical study
Author(s) -
Ferrer Miquel,
Torres Antoni,
Martínez Raquel,
Ramírez Paula,
Polverino Eva,
Montull Beatriz,
Sialer Salvador,
Niederman Michael S.,
Agusti Alvar,
Menéndez Rosario
Publication year - 2014
Publication title -
respirology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.857
H-Index - 85
eISSN - 1440-1843
pISSN - 1323-7799
DOI - 10.1111/resp.12324
Subject(s) - medicine , copd , pneumonia , confounding , asthma , prospective cohort study , community acquired pneumonia , inhaled corticosteroids , gastroenterology , mortality rate
Background and objective The previous use of inhaled corticosteroids ( ICS ) may reduce the inflammatory response and mortality in patients with community‐acquired pneumonia ( CAP ). Methods We measured serum levels of several inflammatory biomarkers, as well as mortality at various time‐points, in 663 consecutive patients hospitalized for CAP ; 128 (19%) were receiving chronic outpatient treatment with ICS . Patients on previous oral corticosteroids were excluded from the analysis. Results On admission, patients treated with ICS were older; had been diagnosed with chronic obstructive pulmonary disease ( COPD ), asthma and pneumonia in the previous year more often; and had higher CAP severity risk classes and lower tumour necrosis factor ( TNF )‐alpha ( P < 0.001) and interleukin ( IL )‐6 ( P = 0.015) serum levels. After adjusting for potential confounders, this association persisted for TNF ‐alpha ( P < 0.001), but not for IL ‐6. Mortality at 30 and 90 days tended to be lower in patients treated with ICS ( P = 0.062 and 0.050, respectively), but mortality was similar after 1 year in both groups (16, 13% vs 81, 15% for patients treated and not treated with ICS , respectively). Hospital readmission rate after 1 year was higher in patients treated with ICS (49, 38% vs 109, 20%, P < 0.001). The association of ICS treatment with a previous diagnosis of pneumonia, lower levels of TNF ‐alpha and IL ‐6 on admission and higher readmission rates during follow up persisted in the subpopulation of 210 patients with COPD . Conclusions Previous use of ICS in patients hospitalized for CAP is associated with a reduced systemic inflammatory response without any impact on long‐term mortality.