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Inhaled corticosteroids increase risk for pneumonia in patients with asthma

Use of inhaled corticosteroids, including budesonide and fluticasone, was associated with an increased risk of pneumonia in patients with asthma, according to data published in British Journal of Clinical Pharmacology.

“Inhaled corticosteroids (ICS) are the first-line treatment for patients with persistent asthma. ... However, complications have been found to be linked to ICS use, including reduction in bone density, ocular hypertension, skin bruising, diabetes onset and progression, suppression of growth in children and decreased immunity,” Christina J. Qian, MSc, from the department of epidemiology, biostatistics and occupational health at McGill University in Quebec, and colleagues wrote. “While the increase in risk of pneumonia in association with ICS use in patients with [chronic obstructive pulmonary disease] seems clear, the risk in asthma patients remains contentious.”

Researchers examined whether ICS use was associated with a heightened risk for pneumonia, and whether the risk differed according to dose and type of ICS in patients with asthma aged 12 to 35 years. They performed a population-based cohort study of patients treated for asthma from 1990 to 2007 who had an ICS dispensed within the 60 days prior to their pneumonia index event or matched person-moment. Using a quasi-cohort approach, they estimated rate ratios and rate differences of 152,412 patients.

Among the patients, 1,928 had a pneumonia event during follow-up. The results showed an increased risk for pneumonia correlated with current use of ICS (RR = 1.83; 95% CI, 1.57-2.14) or an excess risk of 2.03 cases per 1,000 person-years (rate difference = 1.44; 95% CI, 1.03-1.85). The investigators found an excess pneumonia risk with low, moderate and high doses of ICS, compared with no ICS use. They also observed a statistically significantly increased risk of pneumonia with budesonide (RR = 2.67; 95% CI, 2.05-3.49) and fluticasone (RR = 1.93; 95% CI, 1.58-2.36) relative to no ICS use. The risk with current use of ICS was reduced when accounting for potential protopathic bias (RR = 1.48; 95% CI, 1.22-1.78).

“This study shows that the risk of pneumonia, in particular, serious pneumonia leading to hospitalization, in asthma patients is indeed elevated in relation to ICS use,” Qian and colleagues wrote. “When assuring that only patients actively treated with asthma are included and that the use of ICS is not in fact a marker for early signs of pneumonia, the increase in risk is relatively small. In future studies, it would be helpful to further validate the diagnosis of pneumonia, identify subjects with a confirmed diagnosis of asthma and to adjust for smoking.” – by Savannah Demko

Disclosures: Qian reports no relevant financial disclosures. Please see the full study for a complete list of all other authors relevant financial disclosures.