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Inhaled corticosteroids and risk of pneumonia in patients with chronic obstructive pulmonary disease: A meta-analysis of randomized controlled trials.
Int Immunopharmacol 2019; 77:105950II

Abstract

OBJECTIVE

Inhaled corticosteroids (ICS) are generally used to treat patients with chronic obstructive pulmonary disease (COPD) who suffer from repeated exacerbations. Recently, it was reported that ICS treatment increased the risk of pneumonia in COPD patients. But it is controversial.The objective of this paper is to clarify the associations between ICS treatment and the risk of pneumonia in COPD patients.

METHODS

PubMed, Cochrane Library, Clinical Trials.gov, and Embase were searched from February 2019 to June 2019. Randomized clinical trials (RCTs) were incorporatedthat compared ICS with non-ICS treatment on the risk of pneumonia in COPD patients. Meta-analyses were conducted by the Peto and Mantel-Haenszel approaches with corresponding 95% CIs.

RESULTS

Twenty-five trials (N = 49,982 subjects) were included. Pooled results demonstrated a significantly increased risk of pneumonia with ICS use in COPD patients (RR, 1.59, 95% CI, 1.33-1.90; I2 = 51%). ICS treatment also increased the risk of severe pneumonia (RR, 2.17, 95% CI, 1.47-3.22; I2 = 29%). The results of subgroup analysis based on doses of ICS were consistent with the above. However, subgroup analyses based on types of ICS revealed that fluticasone therapy was associated with an increased risk of pneumonia but not budesonide. In addition, medium- and low-doses of budesonide treatment also did not increase the risk of pneumonia.

CONCLUSIONS

Use of ICS increases the risk of pneumonia in patients with COPD. The above is prominent for fluticasone-containing ICSs but not for budesonide-containing ICSs.

Authors+Show Affiliations

Respiratory Diseases Laboratory, Chengdu Second People's Hospital, Chengdu, China.Respiratory Diseases Laboratory, Chengdu Second People's Hospital, Chengdu, China.Respiratory Diseases Laboratory, Chengdu Second People's Hospital, Chengdu, China.Department of Respiratory Medicine, the Second Affiliated Hospital, Chongqing Medical University, Chongqing, China. Electronic address: depengjiang@163.com.Respiratory Diseases Laboratory, Chengdu Second People's Hospital, Chengdu, China. Electronic address: eyyhxyjs@126.com.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31629940

Citation

Yang, Mingjin, et al. "Inhaled Corticosteroids and Risk of Pneumonia in Patients With Chronic Obstructive Pulmonary Disease: a Meta-analysis of Randomized Controlled Trials." International Immunopharmacology, vol. 77, 2019, p. 105950.
Yang M, Du Y, Chen H, et al. Inhaled corticosteroids and risk of pneumonia in patients with chronic obstructive pulmonary disease: A meta-analysis of randomized controlled trials. Int Immunopharmacol. 2019;77:105950.
Yang, M., Du, Y., Chen, H., Jiang, D., & Xu, Z. (2019). Inhaled corticosteroids and risk of pneumonia in patients with chronic obstructive pulmonary disease: A meta-analysis of randomized controlled trials. International Immunopharmacology, 77, p. 105950. doi:10.1016/j.intimp.2019.105950.
Yang M, et al. Inhaled Corticosteroids and Risk of Pneumonia in Patients With Chronic Obstructive Pulmonary Disease: a Meta-analysis of Randomized Controlled Trials. Int Immunopharmacol. 2019 Oct 17;77:105950. PubMed PMID: 31629940.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Inhaled corticosteroids and risk of pneumonia in patients with chronic obstructive pulmonary disease: A meta-analysis of randomized controlled trials. AU - Yang,Mingjin, AU - Du,Yuejun, AU - Chen,Hong, AU - Jiang,Depeng, AU - Xu,Zhibo, Y1 - 2019/10/17/ PY - 2019/08/04/received PY - 2019/09/19/revised PY - 2019/09/29/accepted PY - 2019/10/21/pubmed PY - 2019/10/21/medline PY - 2019/10/21/entrez KW - Chronic obstructive pulmonary disease (COPD) KW - Inhaled corticosteroids (ICS) KW - Meta-analysis KW - Pneumonia KW - Risk SP - 105950 EP - 105950 JF - International immunopharmacology JO - Int. Immunopharmacol. VL - 77 N2 - OBJECTIVE: Inhaled corticosteroids (ICS) are generally used to treat patients with chronic obstructive pulmonary disease (COPD) who suffer from repeated exacerbations. Recently, it was reported that ICS treatment increased the risk of pneumonia in COPD patients. But it is controversial.The objective of this paper is to clarify the associations between ICS treatment and the risk of pneumonia in COPD patients. METHODS: PubMed, Cochrane Library, Clinical Trials.gov, and Embase were searched from February 2019 to June 2019. Randomized clinical trials (RCTs) were incorporatedthat compared ICS with non-ICS treatment on the risk of pneumonia in COPD patients. Meta-analyses were conducted by the Peto and Mantel-Haenszel approaches with corresponding 95% CIs. RESULTS: Twenty-five trials (N = 49,982 subjects) were included. Pooled results demonstrated a significantly increased risk of pneumonia with ICS use in COPD patients (RR, 1.59, 95% CI, 1.33-1.90; I2 = 51%). ICS treatment also increased the risk of severe pneumonia (RR, 2.17, 95% CI, 1.47-3.22; I2 = 29%). The results of subgroup analysis based on doses of ICS were consistent with the above. However, subgroup analyses based on types of ICS revealed that fluticasone therapy was associated with an increased risk of pneumonia but not budesonide. In addition, medium- and low-doses of budesonide treatment also did not increase the risk of pneumonia. CONCLUSIONS: Use of ICS increases the risk of pneumonia in patients with COPD. The above is prominent for fluticasone-containing ICSs but not for budesonide-containing ICSs. SN - 1878-1705 UR - https://www.unboundmedicine.com/medline/citation/31629940/Inhaled_corticosteroids_and_risk_of_pneumonia_in_patients_with_chronic_obstructive_pulmonary_disease:_A_meta-analysis_of_randomized_controlled_trials L2 - https://linkinghub.elsevier.com/retrieve/pii/S1567-5769(19)31737-0 DB - PRIME DP - Unbound Medicine ER -