Tuğba ÖNALAN, Ayşegül BAYSAK, Jülide EMRE ÇELDİR, Özer ÖZDEMİR, Mustafa Hikmet ÖZHAN

Kombine preparat ya da tek başına uzun etkili beta agonist kullanan kronik obstrüktif akciğer hastalığı olgularında pnömoni gelişme oranının retrospektif olarak karşılaştırılması

Amaç: Son çalışmalarda, kronik obstrüktif akciğer hastalığı (KOAH) olgularında k ombine preparat (uzun etkili beta agonist+inhale steroid) kullanımının pnömoni riskini arttıracağına dair bazı veriler el de edilmiştir. Bu retrospektif çalışmanın amacı, düzenli olarak inhale kombine preparat ya da sadece uzun etkili beta 2 agonist (long acting beta 2 agonist, LABA) kullanan KOAH olgularında pnömoni gelişim oranlarını karşılaştırmaktır. Gereç ve Yöntem : Altm ış iki 62 KOAH olgusu çalışmaya alın dı. Hastalar kullandıkları inhale ajana göre kombine grubu (31 olgu ; 26 erkek, 5 kadın ; ortalama yaş±SS: 68±9) ve LABA grubu (31 olgu ; 27 erkek, 4 kadın , ortalama yaş±SS: 66±8) olarak iki gruba ayrıl dı. Hasta dosyaları retrospektif olarak incelen di ve her hastayla telefonla görüşül dü . Bulgular: Hastalık ağırlık derecesi kombine grubunda 10 hasta ve LABA grubunda 8 hasta ağır ya da çok ağır (FEV1

Retrospective comparison of pneumonia occurence in patients wi th chronic obstructive pulmonary disease using inhaled combination or inhaled long acting beta agonist alone

Aim: Data from recent studies revealed that the use of combinations of inhaled corticosteroids and long acting beta 2 agonists (LABA) may increase pneumonia risk in chronic obstructive pulmonary disease (COPD) patients. The aim of this retrospective study is to compare the occurence of pneumonia in COPD patients who received regularly inhaled corticosteroid and LABA combinations with the patients who received inhaled LABA only. Materials and Methods: Sixty-two COPD patients were included in the study. Patients were divided into 2 groups according to the inhaled agents they used; combination group (31 patients; 26 male , 5 female ; median age±SD : 68±9) and LABA group (31 patients; 27 male , 4 female ; median age±SD: 66±8). Medical recotds of patients were retrospectively evaluated and all patients were contacted via telephone.Results: Ten patients in combination group had severe or very severe COPD (FEV 1 <50% ) versus 8 patients in LABA group. Seventeen episodes (54% ) of pneumonia was detected in the combination group, whereas 10 (32% ) in LABA group (p=0.06). Diabetes mellitus was present as a comorbidity in two patients in the combination group and in three in the LABA group. Conclusion: Since study population was limited, statistical difference between the two groups was found to be insignificant. But, there was a trend of higher incidence of pneumonia in the combination group, similar to previous studies.

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1. Celli BR, MacNee W; ATS/ERS Task Force. Standards for the diagnosis and treatment of patients with COPD: A summary of the ATS/ERS position paper. Eur Respir J 2004;23(6):932 -46 .
2. O'Donnell DE, Hernandez P, Kaplan A, et al. Canadian Thoracic Society recommendations for management of chronic obstructive pulmonary d isease - 2008 update - highlights for primary care. Can Respir J 2008;15(Suppl A):1A-8A.
3. National Collaborating Centre for Chronic Conditions. Chronic obstructive pulmonary disease. National clinical guideline on management of chronic obstructive pulmonary disease in adults in primary and secondary care. Thorax 2004;59(Suppl 1):1 - 232 .
4. Toraks Derneği KOAH Çalışma G rubu. Kronik Obstrüktif Akciğer Hastalığı Tanı ve Tedavi Rehberi. Toraks Dergisi 2000;1 (1):1 - 66 .
5. Kocabas A, Hancioglu A, Turkyilmaz S, et al. Pre valence of COPD in Adana, Turkey (BOLD-Turkey Study) . In : Proceedings of the American Thoracic Society 2006;3(Suppl A): A543.
6. Global initiative for chronic obstructive lung disease (GOLD). Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease. Updated 2011. Available from: http://www.goldcopd.com (accessed 21 Sep 2011) .
7. Qaseem A, Wilt TJ, Weinberger SE, et al. Diagnosis and management of stable chronic obstructive pulmonary disease: A clinical practice guideli ne update from the American College of Physicians, American College of Chest Physicians, American Thoracic Society, and European Respiratory Society. Ann Intern Med 2011;155(3):179 -91 .
8. Alsaeedi A, Sin DD, McAlister FA. The effects of inhaled corticosteroid s in chronic obstructive pulmonary disease: A systematic review of randomized placebo -controlled trials. Am J Med 2002;113(1):59 -65 .
9. Sin DD, Wu L, Anderson JA, et al. Inhaled corticosteroids and mortality in chronic obstructive pulmonary disease. Thorax 20 05; 60(12): 992 -7.
10. Sin DD, Tu JV. Inhaled corticosteroids and the risk of mortality and readmission in elderly patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2001;164(4):580 -4 .
11. Kiri VA, Pride NB, Soriano JB, Vestbo J. Inhale d corticosteroids in COPD: Results from two observational designs free of immortal time bias. Am J Resp Crit Care Med 2005;172(4):460 -4 .
12. Tkacova R, Toth S, Sin DD. Inhaled corticosteroids and survival in COPD patients receiving long -term home oxygen therap y. Respir Med 2006;100(3):385 -92 .
13. Yıldırım N. Orta KOAH ta inhaler kortikosteroid / beta -2 agonist tedavisi. Tüberküloz ve Toraks Dergisi 2010;58(2):192 -201 .
14. Briggs AH, Glick HA, Lozano -Ortega G, et al. TOwards a Revolution in COPD Health (TORCH) investiga tors. Is treatment with ICS and LABA cost-effective for COPD? Multinational economic analysis of the TORCH study. Eur Respir J 2010;35(3):532 -9 .
15. Sezer M, Kart L. KOAH Tedavisinde İnhale Kortikosteroidler. Güncel Göğüs Hastalıkları Serisi 2013;1(1):24 -30 .
16. E rnst P, Gonzalez AV, Brassard P, Suissa S. Inhaled corticosteroid use in chronic obstructive pulmonary disease and the risk o f hospitalization for pneumonia. Am J Respir Crit Care Med 2007;176(2):162 -6 .
17. Woodhead M. Inhaled corticosteroids cause pneumonia... or do they? Am J Respir Crit Care Med 2007;176(2):111 -2 .
18. Wedzicha JA, Calverley PM, Seemungal TA, Hagan G, Ansari Z, Stockley RA; INSPIRE Investigators. The prevention of chronic obstructive pulmonary disease exacerbations by salmeterol / fluticasone pro pionate or tiotropium bromide. Am J Respir Crit Care Med 2008;177(1):19 -26.
19. Kiri V, Visick G, Chigbo C, Hagan G, Muellerova H, Davis K. Assessing the incidence pattern of pneumonia among COPD patients with or without exposure to inhaled steroids. Eur Respi r J 2007;30(Suppl 51):628 .
20. Yang IA, Clarke MS, Sim EHA, Fong KM. Inhaled corticosteroids for stable chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews 2012 . DOI: 10.1002/14651858.CD002991.pub3 (published online).