Glucocorticoids inhaled, pneumonia risk

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. 

In an updated meta-analysis of 24 longterm randomized controlled trials involving 23096 participants there was a significantly increased risk of pneumonia with the use of inhaled glucocorticoids in COPD (RR = 1.6 95% Cl=1.4, 1.8) [1 ]. The increased risk of pneumonia was not accompanied by a corresponding increase in mortality. Elderly people and those with more severe disease and reduced lung function had the highest risk. 

The risk of pneumonia in patients with asthma using inhaled glucocorticoids has been evaluated in a meta-analysis of trials of budesonide in asthma [6 ]. The primary data set consisted of 26 double-blind, placebo-controlled trials that lasted at least 3 months (n = 9067 for budesonide and 5926 for the comparator) sponsored by AstraZeneca. In a secondary data set 60 double-blind trials that lasted at least 3 months, but lacked placebo control were evaluated (n = 33496 for budesonide and 2773 for fluticasone propionate). In the primary data set, the occurrence of pneumonia-related adverse events was 0.5% (10/1000 patient-years) for... 

In summary, clinicians should consider the long-term risks of pneumonia with the use of inhaled glucocorticoids in patients with CORD. Adequately powered long-term head-to-head trials with objective definitions of pneumonia, active ascertainment, and radiological and microbiological confirmation are needed to clarify the risk and to identify any intraclass differences between inhaled glucocorticoids. 

In a systematic review of 18 randomized controlled trials the combination of inhaled glucocorticoids - - a LABA was compared with a LABA alone in 12 446 patients with COPD the studies lasted 12-156 weeks [3 ]. There was a significantly increased risk of pneumonia (RR = 1.63 Cl = 1.35,... 

An updated meta-analysis of 24 randomized controlled trials in 23 096 patients with COPD showed that inhaled glucocorticoids were associated with a risk of pneumonia (RR = 1.57 Cl =1.41, 1.75) f6 f However, subgroup analysis showed that although inhaled fluticasone and mometasone were significantly associated with pneumonia, the data on budesonide... 

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