Inhaled corticosteroids raise risk of pneumonia in patients with COPD

Following suggestions in research of a link between pneumonia and inhaled corticosteroids, the researchers reviewed 18 studies involving nearly 17,000 patients.

They compared the incidence of pneumonia in patients who had taken inhaled corticosteroids for at least 24 weeks with patients who had taken a placebo. They also compared patients who had taken a combination of inhaled corticosteroids and long-acting beta-antagonists with those who took long-acting beta- antagonists alone.

Inhaled corticosteroid use – alone or with beta-antagonists – for at least 24 weeks was associated with a 60–70% higher relative risk of pneumonia or serious pneumonia.

‘Given the substantial emerging risk of pneumonia and its associated morbidity and mortality in patients with COPD, and the uncertain benefit of adding an inhaled corticosteroid to a long-acting bronchodilator, clinicians should re-evaluate the benefit-harm profile of long-term inhaled corticosteroid use among patients with COPD,’ the authors said.

NICE guidelines on the management of COPD recommend that inhaled corticosteroids should only be used with beta-antagonists, and only for certain patients.

Jane Scullion, respiratory nurse consultant at University Hospitals of Leicester, said: ‘While studies of the combinations do show improvements in reducing exacerbations, improving quality of life and reducing hospital admissions, we do not still fully understand the role of inhaled corticosteroids in COPD.

‘We should think carefully about patient selection and be vigilant for the development of pneumonia whilst not forgetting that exacerbations can be devastating for patients and increase the risk of death.’

Archives of Internal Medicine (2009) 169: 219–229

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