Journal
CURRENT OPINION IN PULMONARY MEDICINE
Volume 16, Issue 2, Pages 118-122Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/MCP.0b013e328334c085
Keywords
chronic obstructive pulmonary disease; inhaled corticosteroids; pneumonia
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Funding
- Johns Hopkins Clinical Research Scholars Program
- National Center for Research Resources (NCRR) [KL2RR025006-03]
- National Institutes of Health (NIH)
- NIH Roadmap for Medical Research
- NATIONAL CENTER FOR RESEARCH RESOURCES [KL2RR025006] Funding Source: NIH RePORTER
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Purpose of review The aim was to determine the effects of long-term inhaled corticosteroid use on pneumonia in patients with chronic obstructive pulmonary disease (COPD) via systematic searches of MEDLINE, EMBASE, ISI, regulatory documents and manufacturers' trial registries. Recent findings Our updated meta-analysis of 24 long-term randomized controlled trials involving 23 096 participants shows a significantly increased risk of pneumonia with the use of inhaled corticosteroids in COPD (relative risk 1.57, 95% confidence interval 1.41 -1.75, P < 0,0001). The increased risk of pneumonia is not accompanied by a corresponding increase in mortality. The elderly and those with more severe disease and lower forced expiratory volume in 1 s are at the highest risk of pneumonia. The trials of currently available inhaled corticosteroids have included participants with varying duration of inhaled corticosteroid exposure and COPD severity, with apparent differences in the proportion of pneumonia ascertained among these trials. The absence of adequately powered long-term head-to-head trials precludes any definitive conclusions on intraclass differences in risk. Summary Clinicians should consider the long-term risks of pneumonia with the use of inhaled corticosteroids in patients with COPD. Adequately powered long-term head-to-head trials with objective pneumonia definitions, active ascertainment and radiologic and microbiologic confirmation are needed to clarify any intraclass differences in the risk of pneumonia.
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