Researchers from McGill University in Canada showed that interruption of inhaled corticosteroid therapy in Chronic Obstructive Pulmonary Disease may lead to significant reduction in the risk of serious pneumonia. The study entitled “Discontinuation of inhaled corticosteroids in COPD and the risk reduction of pneumonia” was published this June in Chest.
Chronic Obstructive Pulmonary Disease (COPD) is a general designation that includes several progressive lung conditions like emphysema, chronic bronchitis, refractory (non-reversible) asthma, and some forms of bronchiectasis. COPD is characterized generally by increasing breathing difficulty.
In COPD, the widespread use of inhaled corticosteroids as a form of therapy has been questioned. Recent studies on the effect of interrupting the use of inhaled corticosteroids in COPD patients revealed little or no decrease on adverse effects when compared to long-acting bronchodilators. However, is not clear if the suspension of inhaled corticosteroids contributes to the reduction of the high risk of pneumonia linked with these drugs.
The research team used the Quebec health insurance databases and gathered a group of COPD patients treated with inhaled corticosteroids from 1990 to 2005 and followed them up until 2007 or when a severe pneumonia episode occurred, marked by the first hospitalization due to pneumonia or death caused by the infection. They performed a nested case-control analysis of the cohort, which is a type of case-control study that uses its cases and controls from a cohort population that has been followed for a period of time. This type of analysis was used to evaluate if discontinuation of inhaled corticosteroid usage reduced serious pneumonia episodes when compared to continuous usage, and matched for age, sex, respiratory disease severity and co-morbidity.
“We showed a major risk reduction, particularly for fluticasone, using a large population-based cohort with long follow-up,” stated Dr. Samy Suissa, director of the Centre for Clinical Epidemiology at the Lady Davis Institute in Montreal, a log with colleagues in the news release.
The researchers found that patients with COPD who stopped using inhaled corticosteroids were associated with a 25% decrease in the rate of severe pneumonia. This reduction went from 20% in the first month to 50% by the fourth month after stopping the treatment. This decrease was significantly evident with fluticasone, a corticosteroid, but less with budesonide, a glucocorticoid steroid.
“Thus, we conclude that limiting the use of ICS to the patients with COPD who are likely to benefit, such as patients with an asthma component, and weaning the others off ICS will result in a major reduction in the risk of serious pneumonia,” wrote the researchers.