Risk of pneumonia in asthma patients using inhaled corticosteroids: A quasi-cohort approach
Notice bibliographique
Résumé
Background: Inhaled corticosteroids (ICS) are commonly prescribed to patients with persistent asthma as the first-line treatment. Studies of ICS have generally shown a good efficacy and safety profile. However, following the Towards a Revolution in COPD Health (TORCH) trial, several large observational studies were also able to link the use of ICS to excess pneumonia risk in Chronic Obstructive Pulmonary Disease (COPD) patients. The risk of pneumonia in asthma patients using ICS is nevertheless a contentious issue. Methods: We formed a new-user cohort of patients with asthma aged 12 to 35 treated from January 1st, 1990 to December 31st, 2007. Subjects were identified using the Quebec health insurance databases – Régie de l'assurance maladie du Québec (RAMQ) and followed through 2007 or until a pneumonia event, defined as first hospitalization with a diagnosis of pneumonia identified in the RAMQ hospitalization database, including deaths due to pneumonia. A quasi-cohort approach was used where all cases of pneumonia were identified and the quasi-cohort (controls) consisted of 10 person-days per case, selected by incidence density random sampling from all person-days of follow-up in the cohort. Subjects were considered currently exposed if they had an ICS prescription 60 days prior to their index person-moment. Secondary analyses were also done to investigate possible relationships of pneumonia onset and ICS doses, as well as types. A quasi-cohort approach with conditional logistic regression was then used to estimate the rate ratio (RR) and the rate differences (RD) of pneumonia associated with ICS use, adjusted for age, sex, asthma severity, and several related comorbidities. Sensitivity analyses were also performed to explore possible biases.Results: The study cohort included 152,412 patients, of which 1928 had a pneumonia event in the average of 4.1 years of follow up (incidence rate 3.1 per 1000 per year). Using the 1928 cases and 19,275 quasi-cohort person-days, current ICS use is associated with an 83% increase in the rate of pneumonia (RR 1.83; 95% CI 1.57 to 2.14), or an excess of 2.16 cases per 1000 person-years (RD 2.16; 95% CI 1.41 to 2.91). High doses of ICS (fluticasone equivalent dose: >500 μg/day) is associated with a 96% increase in rate of pneumonia (RR 1.96; 95% CI 1.64 to 2.34) or an excess of 2.42 cases per 1000 person-years (RD 2.42; 95% CI 1.52 to 3.33). The rate of pneumonia is also found to be higher in users of budesonide (RR 2.67; 95% CI 2.05 to 3.49 & RD 3.42; 95% CI 1.66 to 5.19) and fluticasone (RR 1.93; 95% CI 1.58 to 2.36 & RD 2.47; 95% CI 1.38 to 3.57) as compared to other classes of ICS (RR 1.23; 95% CI 0.92 to 1.63 & RD 1.16; 95% CI -0.19 to 2.51), which include beclomethasone, ciclesonide, and triamcinolone. Sensitivity analyses overall yield consistent results, except one which suggests potential protopathic bias through its decreased magnitude of risk (RR 1.48; 95% CI 1.22 to 2.78). Conclusions: ICS use in asthma patients is associated with an increased risk of pneumonia, particularly with high doses and with both budesonide and fluticasone. These findings require replication in view of the observed potential protopathic bias.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,031 | 0,027 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,001 | 0,004 |
| Bibliométrie | 0,002 | 0,001 |
| Études des sciences et des technologies | 0,002 | 0,001 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,003 | 0,002 |
| Intégrité de la recherche | 0,002 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,005 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».