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Inhaled corticosteroids not linked to increased pneumonia risk in children with asthma
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The regular use of inhaled corticosteroids is unlikely to increase the risk for pneumonia and other respiratory infections in children with asthma, according to findings from a systematic review published in Pediatrics.
“[Inhaled corticosteroids] are generally considered safe and well tolerated in both adults and children,” Cristine Cazeiro, BSN, of Federal University of Rio Grande in Brazil, and colleagues wrote. “However, recent studies have raised concerns about increased risk of pneumonia related to regular use of ICS in adult patients with chronic obstructive pulmonary disease.”
To assess the association between ICS use and risk for respiratory infections in children with asthma, the researchers searched PubMed, clinicaltrials.gov and pharmaceutical manufacturer databases to analyze randomized trials that compared ICS use with placebo for at least 4 weeks in children with asthma.
Thirty-one trials involving 11,615 patients (n = 4,150 placebo) were used for the meta-analyses, with the requirements that studies consist of randomized controlled trials, and patients should have used a daily ICS for at least 4 weeks, compared with placebo delivered by the same type of device. Researchers excluded trials that compared ICS to other interventions without placebo, crossover trials and trials that used ICS plus other drugs.
The duration of intervention in contributing studies varied from 4 weeks to 3 years. Nine trials identified at least one instance of pneumonia in a cohort of 2,684 patients treated with an ICS and 1,933 treated with placebo
The researchers found that pneumonia occurred in 0.58% of patients who received an ICS and 1.51% of patients who received placebo. In addition, the meta-analysis of all the trials identified no significant difference in the risk for pneumonia between the ICS and placebo groups (RD = –0.1%; 95% CI, –0.3%-0.2%). Furthermore, the meta-analysis indicated that ICS use reduced the risk for pneumonia compared with placebo (RR = 0.65; 95% CI, 0.44-0.94).
The researchers identified that there were no significant associations between ICS use and risk for pharyngitis (RR = 1.01; 95% CI, 0.87-1.18), otitis media (RR = 1.07; 95% CI, 0.83-1.37 and sinusitis (RR = 0.89; 95% CI, 0.76-1.05).
The researchers acknowledged that although the results indicated that the regular use of ICS are unlikely to increase the risk for pneumonia and other respiratory infections, caution should be taken when interpreting these results.
“Meta-analysis may overestimate the incidence of pneumonia if excluding the trials in which no events of pneumonia were reported in either arm,” Cazeiro and colleagues wrote. “[In addition,] asthma exacerbations could be easily misclassified as pneumonia given the lack of clearly defined criteria for pneumonia in the trials and similar clinical manifestations between pneumonia and asthma exacerbation.” – by Ryan McDonald
Disclosure: The researchers report no relevant financial disclosures.
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