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Steroid inhalers linked to higher risk of hard-to-treat infections

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Older people who use steroid inhalers for asthma or chronic obstructive pulmonary disease are more likely to experience particular bacterial infections, according to a large Canadian study.

As a result, researchers said clinicians should carefully consider the potential benefits and harms of steroid inhalers in patients with asthma or COPD, especially the latter.

“Clinicians should carefully consider the potential benefits and harms of steroid inhalers”

Sarah Brode

Their research suggested the inhalers increased the risk of lung infections caused by nontuberculous mycobacteria, which are notoriously difficult to treat and resistant to a number of common antibiotics.

The study, published in the European Respiratory Journal, included 417,494 people with COPD or asthma aged 66 and older, who had all been prescribed medicine for their condition at least once.

Out of these patients, who were all from Ontario in Canada, the researchers found that 2,966 had also been diagnosed with nontuberculous mycobacteria infections.

The researchers then compared this information with whether the patients used a steroid inhaler, what type of steroid they had used, and how much they had used it.

“Infections caused by nontuberculous mycobacteria are serious and difficult to treat”

Guy Brusselle

They found that patients currently using steroid inhalers were around twice as likely to be diagnosed with an infection of this type, and the longer they had been taking the steroid, the greater the risk.

Lead study author Dr Sarah Brode, assistant professor of medicine at the University of Toronto, said: “These infections are not particularly common but they are chronic and difficult to treat, and are associated with an increased risk of death.

“Treatment typically requires at least three antibiotics given for longer than a year and this can still fail to tackle the infection,” she highlighted.

The study authors also discovered that one type of steroid in particular, fluticasone, was particularly significant in terms of risk. In contrast, they found no significant risk for budesonide.

University of Toronto

Steroid inhalers linked to higher risk of hard-to-treat infections

Sarah Brode

Previous research had suggested that steroid inhalers could hamper the body’s ability to fight infections by reducing or impairing the cells of the immune system, noted the researchers.

Dr Brode stressed that steroid inhalers were “critical” treatments for managing asthma symptoms for most patients but were “less important” in the management of COPD.

“They may only provide more benefit than harm in a sub-set of COPD patients,” she said. “There is an ongoing debate on which patients with COPD should be treated with inhaled steroids.

“This research suggests that patients should discuss whether they need to use steroid inhalers with their clinicians, and whether the benefits outweigh the potential harms. If they do need to use them, they should be on the lowest effective dose,” she said.

She added: “Clinicians should carefully consider the potential benefits and harms of steroid inhalers in patients with asthma or COPD, especially those who have already had an infection of this type in the past.”

European Respiratory Society

Steroid inhalers linked to higher risk of hard-to-treat infections

Guy Brusselle

Dr Brode and her colleagues are currently investigating which treatments might be most effective against nontuberculous mycobacteria infections in the same group of Canadian patients.

Professor Guy Brusselle, science council chair of the European Respiratory Society, said: “This is a large and important observational study on the effects of steroid inhalers in older people with asthma and COPD.

“Although not common, infections caused by nontuberculous mycobacteria are serious and difficult to treat,” he said.  

He added: “We must consider the effects of steroid inhalers on the risk of these infections alongside their known benefits and side-effects.”

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