Inhaled Corticosteroid Use for COPD Treatment Linked to Increased Risk of Pneumonia

The use of fluticasone-containing inhaled corticosteroids (ICS) was linked to increased risk of pneumonia in patients with chronic obstructive pulmonary disease (COPD), according to an October study published in International Immunopharmacology.

ICS are the typical treatment administered to patients with COPD who suffer from repeated exacerbations. A previous study exhibited associations between ICS treatment and an increased risk of developing pneumonia in patients with COPD, but evidence has remained controversial. Researchers sought to clarify the results of this link by conducting a meta-analysis of randomized controlled trials (RCT) derived from PubMed, Cochrane Library, ClinicalTrials.gov, and Embase between February 2019 and June 2019.

The incorporated RCTs compared ICS versus non-ICS treatment (long-acting beta agonists, long-acting muscarinic antagonists, or placebo) on the risk of pneumonia in patients with COPD. The meta-analysis included 25 trials comprising 49,982 patients, and the analysis was conducted by the Peto and Mantel-Haenszel approaches.

Pooled study results demonstrated a significant association for ICS usage and increased risk of pneumonia in patients with COPD (risk ratio [RR], 1.59; 95% CI, 1.33-1.90). ICS treatment was additionally shown to starkly increase the risk of severe pneumonia (RR, 2.17, 95% CI, 1.47-3.22), with the subgroup analysis based on doses of ICS showing consistent findings as well.

The results of the subgroup analysis based on types of ICS, however, showed that fluticasone therapy was associated with an increased risk of pneumonia in patients with COPD, while budesonide therapy was not. In medium and low-doses of budesonide treatment, no link was found for increased risk to pneumonia. The study authors said that this may be because “fluticasone could suppress effectively innate immunoresponse to bacterial triggers in alveolar macrophages,” as reported in previous studies, and that this effect “could be up to tenfold greater than that of budesonide in the human airway/lungs.”

As many patients with COPD utilize ICS to inhibit exacerbations, delineating which type is effective in not only treating these issues but also in limiting related side effects in this patient demographic is crucial for quality care. Currently, the 5-year mortality rate for people with COPD typically ranges from 40% to 70%, while the 2-year mortality rate for people with severe COPD is approximately 50%. By avoiding complications deriving from a potentially fatal illness such as pneumonia, patients may benefit from improved quality of life and safer treatment.

Reference

Yang M, Du Y, Chen H, et al. Inhaled corticosteroids and risk of pneumonia in patients with chronic obstructive pulmonary disease [published online October 17, 2019]. Int Immunopharmacol. doi: 10.1016/j.intimp.2019.105950.