Increase Pneumonia Risk in Asthma With Inhaled Corticosteroids Use
The risk of pneumonia with current use of inhaled corticosteroids was attenuated when accounting for potential protopathic bias.
The use of inhaled corticosteroids, including budesonide and fluticasone, is associated with an increased risk of pneumonia in patients with asthma, according to a study published in the British Journal of Clinical Pharmacology.
Pierre Ernst, MD, MSc, from McGill University and Jewish General Hospital in Montreal, and colleagues conducted a quasi-cohort study to examine the risk of pneumonia with inhaled corticosteroids in 152,412 asthma patients between 12 and 35 years of age who were treated from 1990 to 2007.
The participants were considered “currently exposed” if they dispensed inhaled corticosteroids within 60 days prior to their pneumonia index event or matched person-moment.
The investigators also conducted a secondary analysis to determine the risk of pneumonia according to inhaled corticosteroid dose and type.
A total of 1,928 participants had a pneumonia event during follow-up. The researchers observed an increased risk of pneumonia associated with current-use of inhaled corticosteroids (rate ratio [RR], 1.83) or an excess risk of 2.03 cases per 1,000 person-years (rate difference [RD], 1.44).
Compared with those who were not currently using inhaled corticosteroids, an excess pneumonia risk was observed with low doses (RR, 1.60), moderate doses (RR, 1.53), and high doses of inhaled corticosteroids (RR, 1.96). There was an excess pneumonia risk with budesonide (RR, 2.67) and fluticasone (RR, 1.93) compared with those not currently using inhaled corticosteroids.
The researchers note that the risk of pneumonia with current use of inhaled corticosteroids was attenuated when accounting for potential protopathic bias (RR, 1.48).
“In conclusion, this study shows that the risk for pneumonia, in particular, serious pneumonia leading to hospitalization, in asthma patients is indeed elevated in relation to inhaled corticosteroid use,” the researchers wrote.
“However, when assuring patients that only patients actively treated with asthma are included and that the use of inhaled corticosteroids 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.”
- Qian CJ, Coulombe J, Suissa S, Ernst P. Pneumonia risk in asthma patients using inhaled corticosteroids: A quasi-cohort study. Br J Clin Pharmacol. 2017 Mar 28. doi:10.1111/bcp.13295