Background Inhaled corticosteroids (ICS) are commonly used to treat COPD and are associated with increased risk of pneumonia. The aim of this study was to assess if accumulated use of ICS is associated with a dose-dependent risk of a positive airway culture with Pseudomonas aeruginosa in patients with COPD. Methods We conducted a multiregional epidemiological cohort study including Danish COPD patients followed in outpatient clinics during 2010–2017. ICS use was categorised based on accumulated prescriptions redeemed 365 days prior to cohort entry. Cox proportional hazard regression model was used to estimate the risk of acquiring P. aeruginosa . Propensity score matched models were used as sensitivity analyses. Results A total of 21 408 patients were included in the study, of which 763 (3.6%) acquired P. aeruginosa during follow-up. ICS use was associated with a dose-dependent risk of P. aeruginosa (low ICS dose: HR 1.38, 95% CI 1.03 to 1.84, p=0.03; moderate ICS dose: HR 2.16, 95% CI 1.63 to 2.85, p<0.0001; high ICS dose: HR 3.58, 95% CI 2.75 to 4.65, p<0.0001; reference: no ICS use). A propensity matched model confirmed the results (high ICS dose compared with no/low/moderate ICS dose: HR 2.05, 95% CI 1.76 to 2.39, p p<0.0001). Conclusion Use of ICS in patients with COPD followed in Danish outpatient clinics was associated with a substantially increased and dose-dependent risk of acquiring P. aeruginosa . Caution should be taken when administering high doses of ICS in severely ill patients with COPD. These results should be confirmed in comparable cohorts and other settings. Data may be obtained from a third party and are not publicly available. Due to the Danish legislation regarding sharing of population data, source data collected for this study cannot be made available for others. However, Danish citizens who have a legitimate reason can apply for access to the data via the Danish National Health Authority ().

中文翻译：

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慢性阻塞性肺疾病患者吸入性皮质类固醇的使用和感染铜绿假单胞菌的风险

背景 吸入皮质类固醇 (ICS) 通常用于治疗慢性阻塞性肺病，并与肺炎风险增加相关。本研究的目的是评估 ICS 的累积使用是否与 COPD 患者气道铜绿假单胞菌培养阳性的剂量依赖性风险相关。方法 我们进行了一项多区域流行病学队列研究，其中包括 2010 年至 2017 年门诊随访的丹麦 COPD 患者。ICS 使用情况根据队列进入前 365 天兑换的累积处方进行分类。使用Cox比例风险回归模型来估计感染铜绿假单胞菌的风险。使用倾向评分匹配模型作为敏感性分析。结果共纳入21 408例患者，其中763例（3.6%）在随访期间感染铜绿假单胞菌。ICS 的使用与铜绿假单胞菌的剂量依赖性风险相关（低 ICS 剂量：HR 1.38，95% CI 1.03 至 1.84，p=0.03；中度 ICS 剂量：HR 2.16，95% CI 1.63 至 2.85，p<0.0001 ；高 ICS 剂量：HR 3.58，95% CI 2.75 至 4.65，p<0.0001；参考：未使用 ICS）。倾向匹配模型证实了结果（高 ICS 剂量与无/低/中 ICS 剂量相比：HR 2.05，95% CI 1.76 至 2.39，p p<0.0001）。结论 在丹麦门诊就诊的 COPD 患者中使用 ICS 与感染铜绿假单胞菌的风险大幅增加相关，且风险呈剂量依赖性。对患有 COPD 的重症患者给予高剂量 ICS 时应谨慎。这些结果应该在可比较的队列和其他环境中得到证实。数据可能从第三方获得，并且不公开。由于丹麦关于共享人口数据的立法，本研究收集的源数据无法提供给其他人。然而，有正当理由的丹麦公民可以通过丹麦国家卫生局申请访问数据（）。