October 2, 2013
Inhaled Corticosteroids Significantly Up Pneumonia
Risk for Some

Edmonton, Alberta—For a high-risk population of patients who have already survived one bout of pneumonia, inhaled corticosteroids are associated with a 90% increased risk of repeat occurrences, according to a Canadian study.

Dean Eurich, BSP, PhD, led a University of Alberta research team that examined inhaled corticosteroid use among 6,200 elderly patients with a history of pneumonia and who had a high risk of again developing the infection. The results were published recently in the journal Clinical Infectious Diseases.

During 5 years of follow-up, 653 recurrent pneumonia cases occurred in study subjects with a mean age of 79 years. Of those patients, who were slightly more like to be male, 38% had chronic obstructive pulmonary disease (COPD) and 33% had ever used inhaled corticosteroids (ICS).

Researchers found that, overall, 123 of 870 (14%) current ICS users had recurrent pneumonia compared to 395 of 4603 (9%) never-users (adjusted odds ratio, 1.90; 95% confidence interval, 1.45–2.50; P < .001; number needed to harm = 20). No association was found between past ICS use and greater risk of pneumonia—9% of past users versus 9% never-users (P = .36).

“Given the evidence starting to emerge on inhaled corticosteroids, health professionals have to use their own clinical judgment to try and determine which patients should remain on the drugs, especially for patients with pneumonia,” said Eurich, an associate professor in the School of Public Health and trained pharmacist.

He suggested that pharmacists and other health professionals advise patients to “continue on your medications as your health professional has told you to use them. If you're feeling unwell, if you are coughing or wheezing more, are more short of breath than usual, have chest pain when breathing deeply or coughing, feel fatigued, or develop a fever, see a physician sooner rather than later.”

“ICS use was associated with a 90% relative increase in the risk of recurrent pneumonia among high-risk pneumonia survivors,” the authors write. “This should be considered when prescribing ICS and when deciding which patients might need more intensive follow-up.”

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