Ron Goldberg
In children with asthma, there is no association between use of inhaled corticosteroids (ICS) and the risk for pneumonia hospitalization, according to study findings published in Thorax.
Due to limited and conflicting evidence, it has been unclear whether ICS use in children with asthma was associated with the risk for pneumonia hospitalization. Investigators in Sweden therefore sought to evaluate a possible association between ICS use and risk for pneumonia hospitalization in children with asthma.
The investigators conducted a real-world cohort study that included 424,965 children (2-17 years of age) in Sweden with confirmed asthma from January 2007 through November 2021. Electronic records of dispensed drugs were used to identify patients with new ICS use and no use. Propensity score overlap weighting was used to adjust for potential confounders, and the risk for hospitalization with a primary diagnosis of pneumonia was estimated. Asthma was confirmed using ICD-10 codes from the Swedish National Patient Register and asthma drug dispensing codes from the Swedish Prescribed Drug Register.
The investigators found 369 hospitalizations for pneumonia in the ICS-use cohort (n=249,351) with mean follow-up of 0.9 years, and 181 hospitalizations for pneumonia in the no-use cohort (n=214,840) with mean follow-up of 0.7 years. In the weighted cohort, mean age for ICS use and no-use episodes at baseline was 10.5 years, with 46% girls in both cohorts.
The investigators noted pneumonia-hospitalization weighted incidence rates were 14.5 events/10,000 patient-years in the ICS-use cohort and 14.6/10,000 patient-years in the no-use cohort. Unweighted incidence rates were 15.8 events/10,000 patient-years and 11.5/10,000 patient-years, respectively. Compared with no use, the weighted hazard ratio (HR) for pneumonia hospitalization associated with ICS use was 1.06 (95% CI, 0.88-1.28) and the absolute rate difference was -0.06 (95% CI, -2.83 to 2.72 events/10,000 patient-years). The unweighted HR associated with ICS use was 1.44 (95% CI, 1.21-1.72).
Secondary analysis (including hospitalizations and emergency outpatient visits for pneumonia) showed 1104 events in the ICS-use cohort and 504 events in the non-use cohort. The weighted HR associated with ICS use was 1.10, with subgroup analysis showing the weighted HRs by age groups (0.88 among 2-5 years of age; 0.99 among 6-11 years of age; 1.28 among 12-17 years of age). By sex, weighted HRs were 1.12 for boys and 1.06 for girls.
Further stratified analyses showed the HR for ICS monotherapy use (n=222,872) and pneumonia hospitalization was 1.04, and the HR for use of ICS and long-acting beta agonist (LABA) combination therapy (n=26,692) and pneumonia hospitalization was 1.18. Subgroup analysis by ICS types showed similar HRs comparing budesonide (1.03) and fluticasone (1.05).
Study limitations include unmeasured confounding and outcome and exposure misclassification.
“We found no evidence of an association between ICS use and the risk of hospitalization for pneumonia among children with asthma, as compared with no use,” the investigators concluded. The study authors wrote, “Our findings further support the safety of ICS use for managing asthma in children.”
This article originally appeared on Pulmonology Advisor
References: Sielinou Kamgang KH, Rhedin SA, Almqvist C, Wintzell V. Use of inhaled corticosteroids and the risk of hospitalization for pneumonia in children with asthma: a nationwide cohort study. Thorax. Published online January 6, 2024. doi:10.1136/thorax-2023-220742