Skip to content

Inhaled steroids tied to increased pneumonia risk in asthma patients

April 22, 2017

Inhaled corticosteroid use is a well recognized risk factor for pneumonia hospitalization in patients with COPD, and it may also increase pneumonia risk in patients with asthma.

Use of inhaled steroids was associated with an 83% increased risk of hospitalization for pneumonia among some 150,000 asthma teenage and young adult patients treated in Quebec, Canada, although the absolute risk remained very low.

The risk was greatest in patients who took the highest doses, with daily dosing of 500 μg or more of fluticasone-equivalent associated with a 96% increase in pneumonia hospitalization risk, researcher Pierre Ernst, MD, of McGill University, Montreal, and colleagues, wrote this week in the British Journal of Clinical Pharmacology.

“Pneumonia is a rare event in patients with asthma, unlike COPD,” Ernst told MedPage Today. “Our study suggests an increased risk for pneumonia with inhaled corticosteroid use in asthma patients.”

Ernst and his colleagues were among the first to quantify the increased pneumonia risk associated with inhaled corticosteroid (ICS) use in COPD patients, in a 2007 study finding a more than twofold increased risk among patients taking the highest doses of inhaled steroids.

Inhaled corticosteroids are the first-line treatment for patients with persistent asthma. A 2011 meta-analysis found the treatment to be associated with a significant decrease in pneumonia adverse events and an inconclusive effect on pneumonia severe adverse events.

A 2013 study suggested an almost fourfold increase in S. pneumoniae upper respiratory tract colonization in children using ICS, but in a 2017 meta-analysis researchers concluded that “regular use of inhaled corticosteroids may not increase the risk of pneumonia or other respiratory infections.”

“As a result of these contradictory findings, we conducted a population-based cohort study of treatment patients with asthma to assess whether ICS use is associated with an increased risk for pneumonia, and to evaluate whether the risk varied according to dose and type of ICS,” Ernst and colleagues wrote.

The analysis included 152,412 asthma patients ages 12-25 years identified from 1990 to 2007, who were followed for an average of 4.8 years. The average participant age was 24.2 years and 34.9% were male.

A total of 1,928 patients had an identified asthma hospitalization, confirmed through health insurance databases. Patients were considered currently exposed to ICS if they had an ICS prescription filled within 60 days before the pneumonia index event.

Among the main findings:

  • An increased risk of pneumonia associated with current ICS use was identified (RR 1.83; 95% CI 1.57-2.14) for an excess risk of 2.03 cases per 1,000 person-years (RD 1.44; 95% CI 1.03-1.85)
  • The increase in risk was seen with low doses of ICS (RR 1.60; 95% CI 1.06-2.45), as well as moderate doses (RR 1.53; 95% CI 1.12-2.08), and high doses (RR 1.96; 95% CI 1.64-2.34)
  • Compared to no use of ICU, use of budesonide was associated with a more than twofold risk increase (RR 2.67; 95% CI 2.05-3.49) and a close to twofold risk among users of fluticasone (RR 1.93; 95% CI 1.58-2.36)

“Both budesonide and fluticasone are associated with a statistically significant increase in risk for pneumonia,” the researchers wrote. “Interestingly, while the conclusions of our study are generally consistent with those of previous literature, our study further suggests that budesonide’s risk profile is in fact similar to that of fluticasone.”

They added that after controlling for ICS use being a marker for confounders associated with increased pneumonia risk, the ICS-associated risk was “relatively small.”

“In future studies, it would be helpful to further validate the diagnosis of pneumonia, identify subjects with a confirmed diagnosis of asthma and to adjust for smoking,” they wrote.

“When inhaled corticosteroids are prescribed there is a reason, and we can’t be sure that this reason may be associated with an increased risk for pneumonia,” Ernst said. “That is why additional studies are needed. And physicians should be prescribing the lowest effective dose of this highly effective treatment.”

The researchers reported no funding source.

Researcher Samy Suissa reported receiving grants or other fees from Boehringer-Ingelheim, AstraZeneca, Merck & Co, Novartis and Pfizer.


From → Uncategorized

Leave a Comment

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )


Connecting to %s

%d bloggers like this: