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Inhaled corticosteroids and risk of upper respiratory tract infection in patients with asthma: a meta-analysis.
Infection. 2019 Jun; 47(3):377-385.I

Abstract

BACKGROUND

Recent studies have suggested a possible association between respiratory infection and the use of inhaled corticosteroids (ICS). We aimed to ascertain the risk of upper respiratory tract infection (URTI) with long-term inhaled corticosteroid use among patients with asthma.

METHODS

Through a comprehensive literature search of PubMed, Cochrane Library, EMBASE, and Google Scholar from inception to May 2018, we included randomized controlled trials of any ICS vs. a control treatment for asthma, with reporting of URTI as an adverse event. We conducted meta-analyses by the Peto approaches to generate summary estimates comparing ICS with non-ICS treatment on the risk of URTI.

RESULTS

Seventeen trials (15,336 subjects) were included. Compared with non-ICS treatment, ICSs were associated with a significantly increased risk of URTI (Peto OR, 1.24; 95% CI 1.08-1.42; I2 = 5%, p = 0.002). Subgroup analyses were performed for different dose, both high- and low-dose ICSs were associated with a significantly increased risk of URTI (high dose: Peto OR, 1.46; 95% CI 1.05-2.03; I2 = 0%; p = 0.03) (low dose: Peto OR, 1.20; 95% CI 1.04-1.39; I2 = 25%; p = 0.01). Moreover, fluticasone was observed with an increased risk of URTI (Peto OR, 1.18; 95% CI 1.02-1.38; p = 0.03; heterogeneity: I2 = 21%) but not budesonide, low-dose fluticasone treatment was associated with a significantly higher risk of URTI but not high dose.

CONCLUSIONS

This study raises safety concerns about the risk of URTI associated with ICS use in patients with asthma, but it should be further investigated.

Authors+Show Affiliations

Respiratory Diseases Laboratory, Chengdu Second People's Hospital, No. 10, Qingyun South Street, Chengdu, 610017, China.Digestive System Department, Chengdu Second People's Hospital, Chengdu, China.Respiratory Diseases Laboratory, Chengdu Second People's Hospital, No. 10, Qingyun South Street, Chengdu, 610017, China.Respiratory Diseases Laboratory, Chengdu Second People's Hospital, No. 10, Qingyun South Street, Chengdu, 610017, China.Respiratory Diseases Laboratory, Chengdu Second People's Hospital, No. 10, Qingyun South Street, Chengdu, 610017, China.Respiratory Diseases Laboratory, Chengdu Second People's Hospital, No. 10, Qingyun South Street, Chengdu, 610017, China. eyyhxyjs@126.com.

Pub Type(s)

Journal Article
Meta-Analysis

Language

eng

PubMed ID

30298471

Citation

Yang, Mingjin, et al. "Inhaled Corticosteroids and Risk of Upper Respiratory Tract Infection in Patients With Asthma: a Meta-analysis." Infection, vol. 47, no. 3, 2019, pp. 377-385.
Yang M, Zhang Y, Chen H, et al. Inhaled corticosteroids and risk of upper respiratory tract infection in patients with asthma: a meta-analysis. Infection. 2019;47(3):377-385.
Yang, M., Zhang, Y., Chen, H., Lin, J., Zeng, J., & Xu, Z. (2019). Inhaled corticosteroids and risk of upper respiratory tract infection in patients with asthma: a meta-analysis. Infection, 47(3), 377-385. https://doi.org/10.1007/s15010-018-1229-y
Yang M, et al. Inhaled Corticosteroids and Risk of Upper Respiratory Tract Infection in Patients With Asthma: a Meta-analysis. Infection. 2019;47(3):377-385. PubMed PMID: 30298471.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Inhaled corticosteroids and risk of upper respiratory tract infection in patients with asthma: a meta-analysis. AU - Yang,Mingjin, AU - Zhang,Yan, AU - Chen,Hong, AU - Lin,Jiachen, AU - Zeng,Jiatao, AU - Xu,Zhibo, Y1 - 2018/10/08/ PY - 2018/06/24/received PY - 2018/09/27/accepted PY - 2018/10/10/pubmed PY - 2019/8/31/medline PY - 2018/10/10/entrez KW - Asthma KW - Inhaled corticosteroids (ICS) KW - Meta-analysis KW - Risk KW - Upper respiratory tract infection (URTI) SP - 377 EP - 385 JF - Infection JO - Infection VL - 47 IS - 3 N2 - BACKGROUND: Recent studies have suggested a possible association between respiratory infection and the use of inhaled corticosteroids (ICS). We aimed to ascertain the risk of upper respiratory tract infection (URTI) with long-term inhaled corticosteroid use among patients with asthma. METHODS: Through a comprehensive literature search of PubMed, Cochrane Library, EMBASE, and Google Scholar from inception to May 2018, we included randomized controlled trials of any ICS vs. a control treatment for asthma, with reporting of URTI as an adverse event. We conducted meta-analyses by the Peto approaches to generate summary estimates comparing ICS with non-ICS treatment on the risk of URTI. RESULTS: Seventeen trials (15,336 subjects) were included. Compared with non-ICS treatment, ICSs were associated with a significantly increased risk of URTI (Peto OR, 1.24; 95% CI 1.08-1.42; I2 = 5%, p = 0.002). Subgroup analyses were performed for different dose, both high- and low-dose ICSs were associated with a significantly increased risk of URTI (high dose: Peto OR, 1.46; 95% CI 1.05-2.03; I2 = 0%; p = 0.03) (low dose: Peto OR, 1.20; 95% CI 1.04-1.39; I2 = 25%; p = 0.01). Moreover, fluticasone was observed with an increased risk of URTI (Peto OR, 1.18; 95% CI 1.02-1.38; p = 0.03; heterogeneity: I2 = 21%) but not budesonide, low-dose fluticasone treatment was associated with a significantly higher risk of URTI but not high dose. CONCLUSIONS: This study raises safety concerns about the risk of URTI associated with ICS use in patients with asthma, but it should be further investigated. SN - 1439-0973 UR - https://www.unboundmedicine.com/medline/citation/30298471/Inhaled_corticosteroids_and_risk_of_upper_respiratory_tract_infection_in_patients_with_asthma:_a_meta_analysis_ L2 - https://doi.org/10.1007/s15010-018-1229-y DB - PRIME DP - Unbound Medicine ER -