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Inhaled steroids ‘increase pneumonia risk’ in asthma

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Treatment with inhaled steroids may slightly increase the risk of pneumonia in patients with asthma, as well as those with chronic obstructive pulmonary disease, according to Canadian researchers.

They noted that earlier studies had linked the use of inhaled corticosteroids to excess pneumonia risk in COPD patients, but that the risk in asthma patients had previously remained “unclear”.

“Pneumonia in patients with asthma remains unusual”

Pierre Ernst

The objective of the new study, they said, was to examine the risk of pneumonia with inhaled corticosteroids in asthma patients aged 12 to 35 years old.

The study included 152,412 participants, of which 1,928 had a pneumonia event during the follow-up period.

The researchers calculated that the current use of inhaled corticosteroids was associated with an 83% increased relative risk of being admitted to hospital for pneumonia, compared with no steroid use.

This was equivalent to an excess risk of 2.03 cases per 1,000 person-years, they said.

The increase in relative risk was greatest with higher doses, and dispensing of 500µg or more of fluticasone-equivalent per day was associated with a 96% increase.

Increased risks were seen with both budesonide – 167% increase in risk – and fluticasone – 93% increase in risk.

“Inhaled corticosteroid use in asthma patients appears associated with an increased risk of pneumonia and is present for both budesonide and fluticasone,” said the study authors in the British Journal of Clinical Pharmacology.

Lead author Pierre Ernst, from McGill University and the Jewish General Hospital in Quebec, said: “While the increase in risk of pneumonia with the use of inhaled corticosteroids is well recognised in chronic obstructive pulmonary disease, in asthma patients the evidence has been equivocal.”

“Our study suggests the risk may be present in asthma, although pneumonia in patients with asthma remains unusual and inhaled corticosteroids remain the best therapy available,” he added.

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