Tags

Type your tag names separated by a space and hit enter

Inhaled corticosteroids and the increased risk of pneumonia.
Ther Adv Respir Dis. 2013 Aug; 7(4):225-34.TA

Abstract

Recently it has been suggested that there is a causal association between the use of inhaled corticosteroids (ICSs) and the risk of developing pneumonia in patients with chronic obstructive pulmonary disease (COPD). An increased risk of pneumonia associated with ICS use has been seen in trials with different design, different study populations and with evidence of a dose-response relationship. However, as none of these clinical trials were originally designed to assess pneumonia risk, radiographic confirmation of pneumonia was not always obtained. The extent to which pneumonia events have been confounded with acute exacerbations of COPD is unclear. As increased pneumonia events were not associated with increased mortality it remains unclear what the clinical significance of these findings are. Further complicating the association between ICSs and pneumonia is that meta-analyses restricted to budesonide trials have not shown an increased risk of pneumonia, and no association has been seen in patients with asthma. A number of mechanisms by which ICSs could increase the risk of pneumonia have been proposed, principally related to their immunosuppressive effect. Well-designed clinical trials with predefined endpoints and objective pneumonia definitions are needed before the real risk of pneumonia conferred by ICSs can be established. In the meantime, it seems reasonable to reduce ICSs given to COPD patients to the lowest effective doses, reduce the risk in individual patients by ensuring appropriate vaccination and to be vigilant for the possibility of pneumonia in patients with COPD on ICSs as they largely overlap with those of an acute exacerbation.

Authors+Show Affiliations

CEMIT (Centro Médico Investigadores Tucumán), San Miguel de Tucumán, Tucumán, Argentina.No affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

23445751

Citation

Marzoratti, Lucía, et al. "Inhaled Corticosteroids and the Increased Risk of Pneumonia." Therapeutic Advances in Respiratory Disease, vol. 7, no. 4, 2013, pp. 225-34.
Marzoratti L, Iannella HA, Waterer GW. Inhaled corticosteroids and the increased risk of pneumonia. Ther Adv Respir Dis. 2013;7(4):225-34.
Marzoratti, L., Iannella, H. A., & Waterer, G. W. (2013). Inhaled corticosteroids and the increased risk of pneumonia. Therapeutic Advances in Respiratory Disease, 7(4), 225-34. https://doi.org/10.1177/1753465813480550
Marzoratti L, Iannella HA, Waterer GW. Inhaled Corticosteroids and the Increased Risk of Pneumonia. Ther Adv Respir Dis. 2013;7(4):225-34. PubMed PMID: 23445751.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Inhaled corticosteroids and the increased risk of pneumonia. AU - Marzoratti,Lucía, AU - Iannella,Hernán A, AU - Waterer,Grant W, Y1 - 2013/02/27/ PY - 2013/3/1/entrez PY - 2013/3/1/pubmed PY - 2014/4/4/medline KW - COPD KW - adverse effects KW - inhaled corticosteroids KW - mortality KW - pneumonia SP - 225 EP - 34 JF - Therapeutic advances in respiratory disease JO - Ther Adv Respir Dis VL - 7 IS - 4 N2 - Recently it has been suggested that there is a causal association between the use of inhaled corticosteroids (ICSs) and the risk of developing pneumonia in patients with chronic obstructive pulmonary disease (COPD). An increased risk of pneumonia associated with ICS use has been seen in trials with different design, different study populations and with evidence of a dose-response relationship. However, as none of these clinical trials were originally designed to assess pneumonia risk, radiographic confirmation of pneumonia was not always obtained. The extent to which pneumonia events have been confounded with acute exacerbations of COPD is unclear. As increased pneumonia events were not associated with increased mortality it remains unclear what the clinical significance of these findings are. Further complicating the association between ICSs and pneumonia is that meta-analyses restricted to budesonide trials have not shown an increased risk of pneumonia, and no association has been seen in patients with asthma. A number of mechanisms by which ICSs could increase the risk of pneumonia have been proposed, principally related to their immunosuppressive effect. Well-designed clinical trials with predefined endpoints and objective pneumonia definitions are needed before the real risk of pneumonia conferred by ICSs can be established. In the meantime, it seems reasonable to reduce ICSs given to COPD patients to the lowest effective doses, reduce the risk in individual patients by ensuring appropriate vaccination and to be vigilant for the possibility of pneumonia in patients with COPD on ICSs as they largely overlap with those of an acute exacerbation. SN - 1753-4666 UR - https://www.unboundmedicine.com/medline/citation/23445751/Inhaled_corticosteroids_and_the_increased_risk_of_pneumonia_ L2 - https://journals.sagepub.com/doi/10.1177/1753465813480550?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -