TY - JOUR
T1 - Risk of pneumonia associated with long-term use of inhaled corticosteroids in chronic obstructive pulmonary disease
T2 - A critical review and update
AU - Singh, Sonal
AU - Loke, Yoon K.
N1 - Copyright:
Copyright 2010 Elsevier B.V., All rights reserved.
PY - 2010/3
Y1 - 2010/3
N2 - 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 1s 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.
AB - 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 1s 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.
KW - Chronic obstructive pulmonary disease
KW - Inhaled corticosteroids
KW - Pneumonia
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U2 - 10.1097/MCP.0b013e328334c085
DO - 10.1097/MCP.0b013e328334c085
M3 - Review article
C2 - 19926996
AN - SCOPUS:76449121443
SN - 1070-5287
VL - 16
SP - 118
EP - 122
JO - Current opinion in pulmonary medicine
JF - Current opinion in pulmonary medicine
IS - 2
ER -