Inhaled bronchodilators, such as long-acting muscarinic antagonists (LAMA) and long-acting β 2-agonists (LABA) are regularly administered to reduce COPD symptoms while preventing progression and exacerbation 1. Therefore, appropriate medication selection can help control these factors and reduce both individual and societal costs. Pharmacotherapy and hospitalization due to severe disease, exacerbations, and comorbidities contribute to the economic cost of COPD 3. According to the Global Burden of Disease, COPD was the third leading cause of death worldwide in 2010 2. It is recommended that ICS use be avoided in COPD patients with high pneumonia risk.Ĭhronic obstructive pulmonary disease (COPD) is a progressive chronic disease characterized by persistent respiratory symptoms and airflow limitation 1. The incidence of pneumonia was higher in COPD patients on ICS/LABA compared with those on LAMA.
In multivariable analysis, a history of pneumonia was a risk factor associated with pneumonia (HR 2.123 95% CI 1.580–2.852 p < 0.001). The adjusted hazard ratio (HR) for pneumonia in patients on fluticasone/LABA was 1.496 (95% confidence interval 1.204–1.859) compared with LAMA (p < 0.001). After propensity score matching, the incidence rate per 1000 person-years of pneumonia was 93.96 for LAMA (n = 1003) and 136.42 for ICS/LABA (n = 1003) patients (p < 0.001). We investigated the risk factors associated with pneumonia, including the sub-types of ICS treatments. The primary outcome was pneumonia in COPD patients initiating LAMA or ICS/LABA. We enrolled patients with good compliance (medication possession ratio ≥ 80%). Patients who received COPD medication, either LAMA or ICS/LABA, with the COPD diagnostic code, were selected. This nationwide cohort study used Korean National Health Insurance claim data from January 2002 to April 2016. We aimed to compare the incidence of pneumonia in COPD patients on LAMA and those on ICS/LABA and explored the risk factors associated with pneumonia. Moreover, risk factors for pneumonia in COPD are still unclear. Few studies have directly compared the incidence of pneumonia in patients on common chronic obstructive pulmonary disease (COPD) treatments such as long-acting muscarinic antagonists (LAMA) with those on inhaled corticosteroids and long-acting β 2-agonist (ICS/LABA).
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