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June 3, 2015
Inhaled Corticosteroids Increase Pneumonia in
COPD but Not Mortality

Gainesville, FL—Treatment of chronic obstructive pulmonary disease (COPD) with inhaled corticosteroids raises the likelihood that patients will develop pneumonia but does not increase mortality rates, according to a recent study that suggests it actually might reduce the risk of dying.

The new meta-analysis, conducted by University of Florida researchers, was presented at the 2015 American Thoracic Society International Conference in Denver. Past studies, such as the TORCH (TOwards a Revolution in COPD Health) trial, have shown increased incidence of pneumonia among patients using inhaled corticosteroids (ICS), and the researchers sought to better quantify the associated mortality risks.

“Our systematic review and meta-analysis of 38 studies echoes individual studies which have shown that while ICS may increase the risk of pneumonia in COPD patients, it lowers the risk of both pneumonia-associated and overall mortality,” said lead author Ena Gupta, MD, MPH, of the University of Florida College of Medicine. “This benefit may be due to the immunosuppressive and anti-inflammatory effects of ICS treatment.”

Data from 29 randomized controlled trials and nine observational studies were included in the study. While ICS use was linked to an increased risk of pneumonia in analyses that were not adjusted for possible confounding factors, it was not associated with an increase in pneumonia-associated mortality in the trials. Furthermore, it was associated with a significant decrease in seven observational studies, according to the results.

The report notes that earlier research has indicated a combined immunosuppressive effect and potent anti-inflammatory effect from inhaled corticosteroids, adding, “ICS predisposes COPD patients to an increased risk of incident pneumonia but conversely appears to have a counterbalancing beneficial effect on mortality resulting in no net change, or possibly a slight improvement in mortality.”

“The increase in pneumonia incidence seen with ICS treatment for COPD appears to be counterbalanced by a decrease in mortality,” Gupta explained. “This data can be used to weigh the overall risks and benefits of ICS use in COPD patients.”
U.S. Pharmacist Social Connect