fluticasone and Obesity

Pneumonia is an important cause of morbidity and mortality. COPD patients using inhaled corticosteroids (ICS) have an increased risk of pneumonia, but less is known about whether ICS treatment in asthma also increases the risk of pneumonia. The aim of this analysis was to examine risk factors for hospitalisations with pneumonia in a general population sample with special emphasis on asthma and the use of ICS in asthmatics.. In 1999 to 2000, 7340 subjects aged 28 to 54 years from three Swedish centres completed a brief health questionnaire. This was linked to information on hospitalisations with pneumonia from 2000 to 2010 and treatment with ICS from 2005 to 2010 held within the Swedish National Patient Register and the Swedish Prescribed Drug Register.. Participants with asthma (n = 587) were more likely to be hospitalised with pneumonia than participants without asthma (Hazard Ratio (HR 3.35 (1.97-5.02)). Other risk factors for pneumonia were smoking (HR 1.93 (1.22-3.06)), BMI < 20 kg/m2 (HR 2.74 (1.41-5.36)) or BMI > 30 kg/m2 (HR 2.54 (1.39-4.67)). Asthmatics (n = 586) taking continuous treatment with fluticasone propionate were at an increased risk of being hospitalized with pneumonia (incidence risk ratio (IRR) 7.92 (2.32-27.0) compared to asthmatics that had not used fluticasone propionate, whereas no significant association was found with the use of budesonide (IRR 1.23 (0.36-4.20)).. Having asthma is associated with a three times higher risk of being hospitalised for pneumonia. This analysis also indicates that there are intraclass differences between ICS compounds with respect to pneumonia risk, with an increased risk of pneumonia related to fluticasone propionate.

Topics: Administration, Inhalation; Adult; Asthma; Budesonide; Female; Fluticasone; Glucocorticoids; Hospitalization; Humans; Male; Middle Aged; Obesity; Pneumonia; Proportional Hazards Models; Risk Factors; Smoking; Sweden; Thinness

Obesity may contribute to the development and clinical expression of asthma. However, how obesity can influence response to asthma medications is still uncertain.. To examine the relationship between body mass index (BMI) and the response to an inhaled corticosteroid (ICS), fluticasone propionate, with or without the long-acting beta2-agonist salmeterol (LABA).. Achievement of asthma control as defined by the global initiative on asthma guidelines (GINA) was examined in 1242 asthmatic patients not currently using ICS, enrolled in five clinical trials comparing fluticasone propionate and the combination of fluticasone and salmeterol.. In both obese and non-obese subjects, fluticasone propionate combined with salmeterol was more effective in controlling asthma than fluticasone alone. However, for both treatments the odds of achieving well-controlled asthma were significantly lower in obese subjects, particularly among those with a BMI of >or=40 kg/m2. Reported prevalence of atopy increased with BMI. Age did not influence the effect of obesity in response to asthma medications.. Obese patients are less likely than the non-obese to achieve asthma control with an ICS or an ICS combined with a LABA. The causes of such reduced response to asthma medication in obese subjects should be studied, and their implications for asthma therapy determined.

Topics: Adolescent; Adrenergic beta-Agonists; Adult; Aged; Aged, 80 and over; Albuterol; Androstadienes; Anti-Asthmatic Agents; Asthma; Body Mass Index; Drug Therapy, Combination; Female; Fluticasone; Forced Expiratory Volume; Humans; Male; Middle Aged; Obesity; Odds Ratio; Retrospective Studies; Salmeterol Xinafoate