A recent article published on the Hospitalist revealed that inhaled corticosteroids increase the risk of serious pneumonia in patients with COPD.

Researchers at the Lady Davis Institute from Montreal’s Jewish General Hospital, which included Julieann F. Grant, MD, PhD, D’Anna Saul, MD, Alexis N. Lopez, MD, Anita L. Hart, MD, Mark A. McQuillan, MD, FACP, SFHM; University of Michigan, Ann Arbor, revealed that inhaled corticosteroids increase the risk of serious pneumonia in patients with chronic obstructive pulmonary disease (COPD). The study was published in the journal Thorax.

Although such a correlation was already reported, it was unclear whether this risk varied for different inhaled agents, in particular fluticasone and budesonide. Using the Quebec health insurance database, the research team designed a nested case-control analysis and formed a cohort of 163,514 patients with COPD treated during 1990-2005 and followed it through 2007 or until a serious pneumonia event, such as hospitalization or death from pneumonia, occurred.

Of the total number of patients, 20,344 had a serious pneumonia event during the 5.4 years of follow-up. The use of inhaled corticosteroids (ICS) was associated with a 69% increase in the rate of serious pneumonia, with an increased risk in long-term use of ICS, gradually dropping as patients stopped using the drugs. Consistent with previous clinical trials, fluticasone was found to be the more problematic drug, increasing the risk of serious pneumonia, while with budesonide the chances were much lower.