Objectives Inhaled corticosteroids (ICS) are widely used in patients with chronic obstructive pulmonary disease (COPD). However, ICS are associated with an increased risk of adverse effects. We aimed to determine whether an association between a lower respiratory tract culture with Stenotrophomonas maltophilia and increasing ICS dosing in patients with COPD exists. Design An observational cohort study of outpatients with COPD in Denmark between 2010 and 2018. ICS exposure was categorised into four groups based on average daily consumption 1 year prior to inclusion: no use, low ICS dose (≤400 µg), moderate ICS dose (400–800 µg) and high ICS dose (>800 µg). Dose–response relationship was investigated by a multivariable Cox proportional hazards regression. Results Of the total 22 689 patients, 459 had lower respiratory tract cultures positive for S. maltophilia . The HR of S. maltophilia increased with increasing daily ICS dose: low ICS dose HR 2.6 (95% CI 1.6 to 4.0), moderate ICS dose HR 3.0 (95% CI 1.9 to 4.6) and high ICS dose HR 5.7 (95% CI 3.8 to 8.5). Conclusions We found that ICS was associated with a high, dose-dependent increased hazard of S. maltophilia in outpatients with COPD. High dose users had a nearly six times increased hazard compared with non-users of ICS. When appropriate, attempts at de-escalating ICS treatment should be made. Data may be obtained from a third party and are not publicly available. The data supporting the findings of this study are available from the Danish Health Data Authority following application and approval from the Danish Health Authority. Restrictions apply to the availability of these data, which were used under the licence for this study.

中文翻译：

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慢性阻塞性肺疾病门诊患者吸入皮质类固醇和嗜麦芽窄食单胞菌：一项回顾性队列研究

目的 吸入皮质类固醇（ICS）广泛用于慢性阻塞性肺疾病（COPD）患者。然而，ICS 会增加不良反应的风险。我们的目的是确定下呼吸道培养与嗜麦芽寡养单胞菌和 COPD 患者增加 ICS 剂量之间是否存在关联。设计 对 2010 年至 2018 年间丹麦 COPD 门诊患者进行的一项观察性队列研究。根据纳入前 1 年的平均每日消耗量将 ICS 暴露分为四组：不使用、低 ICS 剂量（≤400 µg）、中度 ICS 剂量（ 400–800 µg）和高 ICS 剂量（>800 µg）。通过多变量 Cox 比例风险回归研究剂量-反应关系。结果 22 689例患者中，459例下呼吸道培养嗜麦芽糖链球菌阳性。嗜麦芽糖链球菌的 HR 随着每日 ICS 剂量的增加而增加：低 ICS 剂量 HR 2.6（95% CI 1.6 至 4.0），中等 ICS 剂量 HR 3.0（95% CI 1.9 至 4.6）和高 ICS 剂量 HR 5.7（95% CI 3.8 至 8.5）。结论 我们发现 ICS 与慢性阻塞性肺病门诊患者中嗜麦芽糖链球菌的高风险、剂量依赖性增加相关。与非 ICS 使用者相比，高剂量使用者的危险增加了近六倍。在适当的情况下，应尝试降低 ICS 治疗的强度。数据可能从第三方获得，并且不公开。经丹麦卫生局申请并批准后，可从丹麦卫生数据局获取支持本研究结果的数据。这些数据的可用性受到限制，这些数据是在本研究的许可下使用的。