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Respiratory Medicine

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Incidence of oral thrush in patients with COPD prescribed inhaled corticosteroids: Effect of drug, dose, and device - 04/11/16

Doi : 10.1016/j.rmed.2016.09.015 
P.N. Richard Dekhuijzen a, Maria Batsiou b, c, Leif Bjermer d, Sinthia Bosnic-Anticevich e, Henry Chrystyn c, f, Alberto Papi g, Roberto Rodríguez-Roisin h, Monica Fletcher i, Lucy Wood c, Alessandra Cifra b, c, Joan B. Soriano j, David B. Price c, k, ⁎
a Radboud University Medical Center, Nijmegen, The Netherlands 
b Cambridge Research Support Ltd, Cambridge, UK 
c Observational and Pragmatic Research Institute Pte Ltd, Singapore 
d Lung Medicine and Allergology, Department of Clinical Sciences, Lund University, Lund, Sweden 
e Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia 
f Faculty of Health and Human Sciences, Plymouth University, Plymouth, UK 
g Respiratory Diseases Unit, Department of Medical Sciences, University of Ferrara, Ferrara, Italy 
h Universitat de Barcelona, Hospital Clínic-IDIBAPS, Barcelona, Spain 
i Education for Health, Warwick, UK 
j Instituto de Investigación Hospital Universitario de la Princesa (IISP), Universidad Autónoma de Madrid, Madrid, Spain 
k Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK 

∗Corresponding author. Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, UK.Academic Primary CareDivision of Applied Health SciencesUniversity of AberdeenPolwarth BuildingForesterhillAberdeenAB25 2ZDUK

Abstract

Background and aims

Little information is available on real-life occurrence of oral thrush in COPD patients treated with ICS. We investigated oral thrush incidence in COPD patients prescribed FDC ICS/LABA therapies and assessed whether it is modulated by the ICS type, dose, and delivery device.

Methods

We conducted a historical, observational, matched cohort study (one baseline year before and one outcome year after initiation of therapy) using data from the UK Optimum Patient Care Research Database. We assessed oral thrush incidence in patients initiating long-acting bronchodilators or FDC ICS/LABA therapy. We then compared different combination therapies (budesonide/formoterol fumarate dihydrate [BUD/FOR] and fluticasone propionate/salmeterol xinafoate [FP/SAL]) and devices (DPI and pMDI).

Results

Patients prescribed FDC ICS/LABA had significantly greater odds of experiencing oral thrush than those prescribed long-acting bronchodilators alone (adjusted OR 2.18 [95% CI 1.84–2.59]). Significantly fewer patients prescribed BUD/FOR DPI developed oral thrush compared with FP/SAL DPI (OR 0.77 [0.63–0.94]) when allowing for differences in prescribed doses between the drugs. A significantly smaller proportion of patients developed oral thrush in the FP/SAL pMDI arm than in the FP/SAL DPI arm (OR 0.67 [0.55–0.82]). Additionally, in the FP/SAL cohort (both DPI and pMDI), increased risk of oral thrush was significantly associated with high ICS daily dose (OR 1.97 [1.22–3.17] vs low daily dose).

Conclusions

ICS use increases oral thrush incidence in COPD and this effect is dose-dependent for FP/SAL therapies. Of the therapies assessed, FP/SAL pMDI and BUD/FOR DPI may be more protective against oral thrush.

Le texte complet de cet article est disponible en PDF.

Highlights

•
Real-life occurrence of oral thrush in patients with COPD prescribed ICS is reported.
•
Effect of different ICS types, doses, and delivery devices is investigated.
•
Some therapeutic strategies are more protective than others against oral thrush.

Le texte complet de cet article est disponible en PDF.

Keywords : Oral candidiasis, Chronic obstructive pulmonary disease, Inhaled corticosteroid, Spacer, Dry powder inhaler, Pressurised metered-dose inhaler


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© 2016  Elsevier Ltd. Tous droits réservés.
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Vol 120

P. 54-63 - novembre 2016 Retour au numéro
Article précédent Article précédent
  • A multicenter, randomized, double-blind dose-ranging study of glycopyrrolate/formoterol fumarate fixed-dose combination metered dose inhaler compared to the monocomponents and open-label tiotropium dry powder inhaler in patients with moderate-to-severe COPD
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  • Donald P. Tashkin, Eric D. Bateman, Paul Jones, Valentina B. Zubek, Norbert Metzdorf, Dacheng Liu, Thomas Leonard, Emmanuelle Clerisme-Beaty, Robert A. Wise

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