Long-Term Use of Inhalers Increases Risk of Pneumonia for COPD Patients

A new study claims that corticosteroid drugs, a popular class of anti-inflammatory inhalers, significantly increases the risk of pneumonia in patients with chronic obstructive pulmonary disease (COPD).

Researchers at Wake Forest University School of Medicine (Winston-Salem, NC, USA) reviewed 18 randomized clinical trials, involving nearly 17,000 patients. The researchers compared the incidence of pneumonia in patients who had taken inhaled corticosteroids for at least 24 weeks compared to patients who had taken a placebo, or patients who had taken a combination of inhaled corticosteroids and long-acting beta-antagonists, compared to patients who took only the long-acting bronchodilator.

An analysis of the study results showed that inhaled corticosteroid use, alone or in combination with bronchodilators, was associated with a 60 to 70% increase in the risk of pneumonia and serious pneumonia; however, it was not associated with an increased risk of death. In absolute terms, the study showed that nearly 1 in every 47 patients with COPD using a corticosteroid inhaler for one year is likely to develop pneumonia linked to use of the drug. The researchers stressed that these results pertain specifically to COPD patients rather than asthma patients, and recommended that clinicians should remain watchful for the development of pneumonia with inhaled corticosteroids, as the signs and symptoms of pneumonia may closely mimic that of COPD exacerbations. The study appears in the February 2009 issue of Archives of Internal Medicine.

"Given the substantial emerging risk of pneumonia and its associated morbidity and mortality in patients with chronic obstructive lung disease, and the uncertain benefit of adding an inhaled corticosteroid to a long-acting bronchodilator, clinicians should re-evaluate the benefit-harm profile of long-term inhaled corticosteroid use among patients with COPD,” said lead author Sonal Singh, M.D., M.P.H., an assistant professor of internal medicine.

Inhaled corticosteroids, which are used either alone or in combination with other drugs for the treatment of asthma, are not approved for use alone in patients with COPD, but rather in combination with beta-antagonists, which dilate the lungs. Available inhaled steroid combinations are fluticasone/salmeterol and budesonide/formoterol. The inhalers are effective in relieving many of the symptoms of COPD.

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