Risk of adverse gastrointestinal events from inhaled corticosteroids

Richard A. Hansen, Wanzhu Tu, Jane Wang, Roberta Ambuehl, Clement J. McDonald, Michael Murray

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Study Objective. To determine whether patients prescribed inhaled corticosteroids are at risk for adverse gastrointestinal effects. Design. Retrospective cohort study. Setting. Urban health center with an academic affiliation. Patients. A total of 19,443 adults (mean age 31.8 yrs) with airways disease, defined as a diagnosis of asthma or chronic obstructive pulmonary disease, and who were prescribed both an inhaled corticosteroid and albuterol (7156 patients) or inhaled albuterol alone (12,287 patients) between November 1977 and February 2002. Measurements and Main Results. The frequency of adverse gastrointestinal events in the patients who used inhaled corticosteroids and albuterol was compared with that in the patients who used albuterol alone. Adverse gastrointestinal outcomes included events such as gastritis, ulcers, and bleeding. Cox proportional hazards models were used to determine the risk of adverse events, controlling for possible confounders such as alcohol use or nonsteroidal antiinflammatory drug use. Adverse gastrointestinal events were observed in 461 (6.4%) patients using inhaled corticosteroids and albuterol and in 302 (2.5%) patients using only albuterol. After controlling for potential confounders, patients who used inhaled corticosteroids and albuterol had an increased risk for adverse gastrointestinal events compared with patients who used only inhaled albuterol (hazard ratio [HR] 1.26, 95% confidence interval [CI] 1.02-1.56). A prescription for a spacer device reduced this risk among patients using an inhaled corticosteroid (HR 0.26, 95% CI 0.20-0.34). Conclusion. Patients using inhaled corticosteroids appear to have a slight risk for adverse gastrointestinal events that is mitigated in patients who used a spacer device.

Original languageEnglish
Pages (from-to)1325-1334
Number of pages10
JournalPharmacotherapy
Volume28
Issue number11 PART 1
DOIs
StatePublished - Nov 2008

Fingerprint

Adrenal Cortex Hormones
Albuterol
Confidence Intervals
Urban Health
Equipment and Supplies
Gastritis
Proportional Hazards Models
Chronic Obstructive Pulmonary Disease
Ulcer
Prescriptions
Cohort Studies
Anti-Inflammatory Agents
Asthma
Retrospective Studies
Alcohols
Hemorrhage

Keywords

  • Asthma
  • Gastrointestinal adverse events
  • Inhaled corticosteroids
  • Obstructive airways disease
  • Spacer

ASJC Scopus subject areas

  • Pharmacology (medical)

Cite this

Risk of adverse gastrointestinal events from inhaled corticosteroids. / Hansen, Richard A.; Tu, Wanzhu; Wang, Jane; Ambuehl, Roberta; McDonald, Clement J.; Murray, Michael.

In: Pharmacotherapy, Vol. 28, No. 11 PART 1, 11.2008, p. 1325-1334.

Research output: Contribution to journalArticle

Hansen, RA, Tu, W, Wang, J, Ambuehl, R, McDonald, CJ & Murray, M 2008, 'Risk of adverse gastrointestinal events from inhaled corticosteroids', Pharmacotherapy, vol. 28, no. 11 PART 1, pp. 1325-1334. https://doi.org/10.1592/phco.28.11.1325
Hansen, Richard A. ; Tu, Wanzhu ; Wang, Jane ; Ambuehl, Roberta ; McDonald, Clement J. ; Murray, Michael. / Risk of adverse gastrointestinal events from inhaled corticosteroids. In: Pharmacotherapy. 2008 ; Vol. 28, No. 11 PART 1. pp. 1325-1334.
@article{e2e8ca842eb74debaefeaa0e06e3b466,
title = "Risk of adverse gastrointestinal events from inhaled corticosteroids",
abstract = "Study Objective. To determine whether patients prescribed inhaled corticosteroids are at risk for adverse gastrointestinal effects. Design. Retrospective cohort study. Setting. Urban health center with an academic affiliation. Patients. A total of 19,443 adults (mean age 31.8 yrs) with airways disease, defined as a diagnosis of asthma or chronic obstructive pulmonary disease, and who were prescribed both an inhaled corticosteroid and albuterol (7156 patients) or inhaled albuterol alone (12,287 patients) between November 1977 and February 2002. Measurements and Main Results. The frequency of adverse gastrointestinal events in the patients who used inhaled corticosteroids and albuterol was compared with that in the patients who used albuterol alone. Adverse gastrointestinal outcomes included events such as gastritis, ulcers, and bleeding. Cox proportional hazards models were used to determine the risk of adverse events, controlling for possible confounders such as alcohol use or nonsteroidal antiinflammatory drug use. Adverse gastrointestinal events were observed in 461 (6.4{\%}) patients using inhaled corticosteroids and albuterol and in 302 (2.5{\%}) patients using only albuterol. After controlling for potential confounders, patients who used inhaled corticosteroids and albuterol had an increased risk for adverse gastrointestinal events compared with patients who used only inhaled albuterol (hazard ratio [HR] 1.26, 95{\%} confidence interval [CI] 1.02-1.56). A prescription for a spacer device reduced this risk among patients using an inhaled corticosteroid (HR 0.26, 95{\%} CI 0.20-0.34). Conclusion. Patients using inhaled corticosteroids appear to have a slight risk for adverse gastrointestinal events that is mitigated in patients who used a spacer device.",
keywords = "Asthma, Gastrointestinal adverse events, Inhaled corticosteroids, Obstructive airways disease, Spacer",
author = "Hansen, {Richard A.} and Wanzhu Tu and Jane Wang and Roberta Ambuehl and McDonald, {Clement J.} and Michael Murray",
year = "2008",
month = "11",
doi = "10.1592/phco.28.11.1325",
language = "English",
volume = "28",
pages = "1325--1334",
journal = "Pharmacotherapy",
issn = "0277-0008",
publisher = "Pharmacotherapy Publications Inc.",
number = "11 PART 1",

}

TY - JOUR

T1 - Risk of adverse gastrointestinal events from inhaled corticosteroids

AU - Hansen, Richard A.

AU - Tu, Wanzhu

AU - Wang, Jane

AU - Ambuehl, Roberta

AU - McDonald, Clement J.

AU - Murray, Michael

PY - 2008/11

Y1 - 2008/11

N2 - Study Objective. To determine whether patients prescribed inhaled corticosteroids are at risk for adverse gastrointestinal effects. Design. Retrospective cohort study. Setting. Urban health center with an academic affiliation. Patients. A total of 19,443 adults (mean age 31.8 yrs) with airways disease, defined as a diagnosis of asthma or chronic obstructive pulmonary disease, and who were prescribed both an inhaled corticosteroid and albuterol (7156 patients) or inhaled albuterol alone (12,287 patients) between November 1977 and February 2002. Measurements and Main Results. The frequency of adverse gastrointestinal events in the patients who used inhaled corticosteroids and albuterol was compared with that in the patients who used albuterol alone. Adverse gastrointestinal outcomes included events such as gastritis, ulcers, and bleeding. Cox proportional hazards models were used to determine the risk of adverse events, controlling for possible confounders such as alcohol use or nonsteroidal antiinflammatory drug use. Adverse gastrointestinal events were observed in 461 (6.4%) patients using inhaled corticosteroids and albuterol and in 302 (2.5%) patients using only albuterol. After controlling for potential confounders, patients who used inhaled corticosteroids and albuterol had an increased risk for adverse gastrointestinal events compared with patients who used only inhaled albuterol (hazard ratio [HR] 1.26, 95% confidence interval [CI] 1.02-1.56). A prescription for a spacer device reduced this risk among patients using an inhaled corticosteroid (HR 0.26, 95% CI 0.20-0.34). Conclusion. Patients using inhaled corticosteroids appear to have a slight risk for adverse gastrointestinal events that is mitigated in patients who used a spacer device.

AB - Study Objective. To determine whether patients prescribed inhaled corticosteroids are at risk for adverse gastrointestinal effects. Design. Retrospective cohort study. Setting. Urban health center with an academic affiliation. Patients. A total of 19,443 adults (mean age 31.8 yrs) with airways disease, defined as a diagnosis of asthma or chronic obstructive pulmonary disease, and who were prescribed both an inhaled corticosteroid and albuterol (7156 patients) or inhaled albuterol alone (12,287 patients) between November 1977 and February 2002. Measurements and Main Results. The frequency of adverse gastrointestinal events in the patients who used inhaled corticosteroids and albuterol was compared with that in the patients who used albuterol alone. Adverse gastrointestinal outcomes included events such as gastritis, ulcers, and bleeding. Cox proportional hazards models were used to determine the risk of adverse events, controlling for possible confounders such as alcohol use or nonsteroidal antiinflammatory drug use. Adverse gastrointestinal events were observed in 461 (6.4%) patients using inhaled corticosteroids and albuterol and in 302 (2.5%) patients using only albuterol. After controlling for potential confounders, patients who used inhaled corticosteroids and albuterol had an increased risk for adverse gastrointestinal events compared with patients who used only inhaled albuterol (hazard ratio [HR] 1.26, 95% confidence interval [CI] 1.02-1.56). A prescription for a spacer device reduced this risk among patients using an inhaled corticosteroid (HR 0.26, 95% CI 0.20-0.34). Conclusion. Patients using inhaled corticosteroids appear to have a slight risk for adverse gastrointestinal events that is mitigated in patients who used a spacer device.

KW - Asthma

KW - Gastrointestinal adverse events

KW - Inhaled corticosteroids

KW - Obstructive airways disease

KW - Spacer

UR - http://www.scopus.com/inward/record.url?scp=55549090341&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=55549090341&partnerID=8YFLogxK

U2 - 10.1592/phco.28.11.1325

DO - 10.1592/phco.28.11.1325

M3 - Article

VL - 28

SP - 1325

EP - 1334

JO - Pharmacotherapy

JF - Pharmacotherapy

SN - 0277-0008

IS - 11 PART 1

ER -