Inhaled Corticosteroid Use Lowers Pneumonia-related Mortality Risk in Patients with COPD

Patients with chronic obstructive pulmonary disease who use inhaled corticosteroids have a decreased risk of dying from pneumonia, but face an increased risk of contracting the infection.

For patients with chronic obstructive pulmonary disease (COPD), inhaled corticosteroids (ICS) use decreases the likelihood of dying from pneumonia, but increases their risk of contracting the infection, according to research presented at the 2015 American Thoracic Society (ATS) International Conference.

Ena Gupta, MD, MPH, of the University of Florida (UF) College of Medicine, and colleagues conducted a systematic review of 38 studies which focused on the health outcomes of COPD patients who were taking ICS.

In doing so, the team highlighted a higher pneumonia prevalence in COPD patients based on the 29 randomized trials (RR 1.61; 95% CI 1.35-1.93, I2=37%, p<.001) and 9 observational studies (OR 1.89; 95% CI 1.39-2.59, I2=99%, p<.001) included in their analysis.

However, 6 randomized trials showed no rise in pneumonia-related deaths (RR 0.91; 95% CI 0.52-1.59, p=.74, I2=0%), while 7 estimable observational studies suggested ICS caused a decrease in pneumonia associated mortality (OR 0.72; 95% CI 0.59-0.88, I2=74%, p=.001).

Moreover, 29 estimable randomized trials estimated no difference in the risk of overall mortality, (RR 0.95; 95% CI 0.85-1.05, I2= 0%, p=.31) and 6 estimable observational studies determined there was a decrease in overall mortality among patients using ICS (OR 0.79; 95% CI 0.65-0.97, I2 =83%, p=.02).

Concluding their study, the researchers cited previous reports which suggest ICS use is related to immunosuppressive and anti-inflammatory effects—something they believe is especially beneficial for COPD patients.

“The increase in pneumonia incidence seen with ICS treatment for COPD appears to be counterbalanced by a decrease in mortality,” Gupta said in a statement. “This data can be used to weigh the overall risks and benefits of ICS use in COPD patients.”