Chronic obstructive pulmonary glucocorticoids inhaled

Mortality associated with glucocorticoid has been retrospectively studied in 556 patients with chronic obstructive pulmonary disease admitted to a rehabilitation center (353). Median survival was 38 months and 280 patients died during follow-up. On multivariate analysis, oral glucocorticoid use at a prednisone equivalent of 10 mg/day without inhaled glucocorticoid was associated with an increased risk of death (RR = 2.34 95% Cl = 1.24, 4.44), and 15 mg/day increased the risk further (RR = 4.03 95% Cl = 1.99, 8.15). The risk of death was not increased in those using 5 mg/day or when patients used any oral dose in combination with inhaled glucocorticoids. 

The association between inhaled glucocorticoids and the risk of pneumonia in patients with chronic obstructive pulmonary disease (COPD) was reviewed in SEDA-33 (p. 353) and SEDA-32 (p. 311). This remains a controversial area, and more data have been published. The EIDOS and DoTS descriptions of this putative adverse reaction are shown in Figure 1. 

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