Association between inhaled corticosteroids and upper respiratory tract infection in patients with chronic obstructive pulmonary disease: a meta-analysis of randomized controlled trials

Abstract Background We aimed to assess the association between inhaled corticosteroids (ICSs) and the risk of upper respiratory tract infection (URTI) in patients with chronic obstructive pulmonary disease (COPD). Methods PubMed, Embase, Cochrane Library and Clinical Trials.gov were searched from in...

Full description

Bibliographic Details
Main Authors: Hong Chen, Yulin Feng, Ke Wang, Jing Yang, Yuejun Du
Format: Article
Language:English
Published: BMC 2020-10-01
Series:BMC Pulmonary Medicine
Subjects:
Online Access:http://link.springer.com/article/10.1186/s12890-020-01315-3
id doaj-a41fa817b50149b597fa29783483a181
record_format Article
spelling doaj-a41fa817b50149b597fa29783483a1812020-11-25T03:56:33ZengBMCBMC Pulmonary Medicine1471-24662020-10-0120111310.1186/s12890-020-01315-3Association between inhaled corticosteroids and upper respiratory tract infection in patients with chronic obstructive pulmonary disease: a meta-analysis of randomized controlled trialsHong Chen0Yulin Feng1Ke Wang2Jing Yang3Yuejun Du4Department of Infectious Disease, Chengdu Second People’s HospitalDepartment of Respiratory Medicine and Critical Care Medicine, West China Hospital, Sichuan UniversityDepartment of Respiratory Medicine and Critical Care Medicine, West China Hospital, Sichuan UniversityDepartment of Respiratory Medicine and Critical Care Medicine, West China Hospital, Sichuan UniversityDepartment of Infectious Disease, Chengdu Second People’s HospitalAbstract Background We aimed to assess the association between inhaled corticosteroids (ICSs) and the risk of upper respiratory tract infection (URTI) in patients with chronic obstructive pulmonary disease (COPD). Methods PubMed, Embase, Cochrane Library and Clinical Trials.gov were searched from inception to October 2019. Randomized controlled trials (RCTs) of any ICSs vs control for COPD with reporting of URTI as an adverse event were included. The study was registered with PROSPERO prospectively (#CRD42020153134). Results Seventeen RCTs (20,478 patients) were included. ICSs significantly increased the risk of URTI in COPD patients (RR, 1.13; 95% CI 1.03–1.24; P = 0.01; heterogeneity: I 2  = 7%). Futher subgroup analyses suggested that short-term use of ICSs increased the risk of URTI (RR, 1.29; 95% CI 1.06–1.56; P = 0.01; heterogeneity: I 2  = 14%) but not for long-term use (RR, 1.08; 95% CI 0.97–1.2; P = 0.14; heterogeneity: I 2  = 0%). Short-term use of high-dose fluticasone increased the risk of URTI (RR, 1.33; 95% CI 1.03–1.71; P = 0.03; heterogeneity: I 2  = 0%) but not for long-term use (RR, 1.12; 95% CI 0.97–1.29; P = 0.13; heterogeneity: I 2  = 50%). Medium-dose (RR, 0.97; 95% CI 0.71–1.32; P = 0.84; heterogeneity: I 2  = 0%) and low-dose (RR, 1.39; 95% CI 0.92–2.1; P = 0.12; heterogeneity: I 2  = 30%) fluticasone did not increase the risk of URTI regardless of duration. Neither mometasone (RR, 1.05; 95% CI 0.87–1.26; P = 0.61; heterogeneity: I 2  = 0%) nor budesonide (RR, 1.08; 95% CI 0.77–1.5; P = 0.67; heterogeneity: I 2  = 46%) increased the risk of URTI, regardless of dosage or duration. Conclusions Long-term use of ICSs does not increase the risk of URTI in patients with COPD. Short-term use of high-dose fluticasone increases the risk of URTI in patients with COPD, but not mometasone or budesonide.http://link.springer.com/article/10.1186/s12890-020-01315-3Inhaled corticosteroids (ICS)Chronic obstructive pulmonary disease (COPD)Upper respiratory tract infection (URTI)RiskMeta-analysis
collection DOAJ
language English
format Article
sources DOAJ
author Hong Chen
Yulin Feng
Ke Wang
Jing Yang
Yuejun Du
spellingShingle Hong Chen
Yulin Feng
Ke Wang
Jing Yang
Yuejun Du
Association between inhaled corticosteroids and upper respiratory tract infection in patients with chronic obstructive pulmonary disease: a meta-analysis of randomized controlled trials
BMC Pulmonary Medicine
Inhaled corticosteroids (ICS)
Chronic obstructive pulmonary disease (COPD)
Upper respiratory tract infection (URTI)
Risk
Meta-analysis
author_facet Hong Chen
Yulin Feng
Ke Wang
Jing Yang
Yuejun Du
author_sort Hong Chen
title Association between inhaled corticosteroids and upper respiratory tract infection in patients with chronic obstructive pulmonary disease: a meta-analysis of randomized controlled trials
title_short Association between inhaled corticosteroids and upper respiratory tract infection in patients with chronic obstructive pulmonary disease: a meta-analysis of randomized controlled trials
title_full Association between inhaled corticosteroids and upper respiratory tract infection in patients with chronic obstructive pulmonary disease: a meta-analysis of randomized controlled trials
title_fullStr Association between inhaled corticosteroids and upper respiratory tract infection in patients with chronic obstructive pulmonary disease: a meta-analysis of randomized controlled trials
title_full_unstemmed Association between inhaled corticosteroids and upper respiratory tract infection in patients with chronic obstructive pulmonary disease: a meta-analysis of randomized controlled trials
title_sort association between inhaled corticosteroids and upper respiratory tract infection in patients with chronic obstructive pulmonary disease: a meta-analysis of randomized controlled trials
publisher BMC
series BMC Pulmonary Medicine
issn 1471-2466
publishDate 2020-10-01
description Abstract Background We aimed to assess the association between inhaled corticosteroids (ICSs) and the risk of upper respiratory tract infection (URTI) in patients with chronic obstructive pulmonary disease (COPD). Methods PubMed, Embase, Cochrane Library and Clinical Trials.gov were searched from inception to October 2019. Randomized controlled trials (RCTs) of any ICSs vs control for COPD with reporting of URTI as an adverse event were included. The study was registered with PROSPERO prospectively (#CRD42020153134). Results Seventeen RCTs (20,478 patients) were included. ICSs significantly increased the risk of URTI in COPD patients (RR, 1.13; 95% CI 1.03–1.24; P = 0.01; heterogeneity: I 2  = 7%). Futher subgroup analyses suggested that short-term use of ICSs increased the risk of URTI (RR, 1.29; 95% CI 1.06–1.56; P = 0.01; heterogeneity: I 2  = 14%) but not for long-term use (RR, 1.08; 95% CI 0.97–1.2; P = 0.14; heterogeneity: I 2  = 0%). Short-term use of high-dose fluticasone increased the risk of URTI (RR, 1.33; 95% CI 1.03–1.71; P = 0.03; heterogeneity: I 2  = 0%) but not for long-term use (RR, 1.12; 95% CI 0.97–1.29; P = 0.13; heterogeneity: I 2  = 50%). Medium-dose (RR, 0.97; 95% CI 0.71–1.32; P = 0.84; heterogeneity: I 2  = 0%) and low-dose (RR, 1.39; 95% CI 0.92–2.1; P = 0.12; heterogeneity: I 2  = 30%) fluticasone did not increase the risk of URTI regardless of duration. Neither mometasone (RR, 1.05; 95% CI 0.87–1.26; P = 0.61; heterogeneity: I 2  = 0%) nor budesonide (RR, 1.08; 95% CI 0.77–1.5; P = 0.67; heterogeneity: I 2  = 46%) increased the risk of URTI, regardless of dosage or duration. Conclusions Long-term use of ICSs does not increase the risk of URTI in patients with COPD. Short-term use of high-dose fluticasone increases the risk of URTI in patients with COPD, but not mometasone or budesonide.
topic Inhaled corticosteroids (ICS)
Chronic obstructive pulmonary disease (COPD)
Upper respiratory tract infection (URTI)
Risk
Meta-analysis
url http://link.springer.com/article/10.1186/s12890-020-01315-3
work_keys_str_mv AT hongchen associationbetweeninhaledcorticosteroidsandupperrespiratorytractinfectioninpatientswithchronicobstructivepulmonarydiseaseametaanalysisofrandomizedcontrolledtrials
AT yulinfeng associationbetweeninhaledcorticosteroidsandupperrespiratorytractinfectioninpatientswithchronicobstructivepulmonarydiseaseametaanalysisofrandomizedcontrolledtrials
AT kewang associationbetweeninhaledcorticosteroidsandupperrespiratorytractinfectioninpatientswithchronicobstructivepulmonarydiseaseametaanalysisofrandomizedcontrolledtrials
AT jingyang associationbetweeninhaledcorticosteroidsandupperrespiratorytractinfectioninpatientswithchronicobstructivepulmonarydiseaseametaanalysisofrandomizedcontrolledtrials
AT yuejundu associationbetweeninhaledcorticosteroidsandupperrespiratorytractinfectioninpatientswithchronicobstructivepulmonarydiseaseametaanalysisofrandomizedcontrolledtrials
_version_ 1724464387444441088