Inhaled Corticosteroids and the Risk of Pneumonia in People with Asthma: McKeever T, Harrison TW, Hubbard R, Shaw D. Chest 2013;144:1788−94.

Abstract

Although there are studies demonstrating a relationship in chronic obstructive pulmonary disease of inhaled corticosteroid use and increased risk of pneumonia, these authors demonstrate a dose-dependent relationship between inhaled corticosteroids in asthma and increased risk of pneumonia and lower respiratory tract infections (LRTI) (p < 0.001 for trend). Through regression analysis of data from The Health Improvement Network the authors retrospectively analyzed data from a cohort and found 6857 patients with asthma and a LRTI. Patients that had asthma and smoked, had a higher Charlson Comorbidity Index score, used more frequent rescue inhalers, required more frequent oral steroid bursts, or were from a lower socioeconomic class, were more likely to develop pneumonia or LRTI. The authors attempted to control for confounders including age, smoking, and the Charlson Comorbidity Index score. They corrected for the number of oral steroids prescribed for exacerbations and rescue inhaler use to decrease confounders of asthma severity. After adjusting for these confounders, there was a dose-dependent relationship where a low beclomethasone dose of ≤ 200 μg showed no increased risk for pneumonia or LRTI, whereas a beclomethasone dose of > 250 μg demonstrated an odds ratio (OR) of 2.44 (95% confidence interval [CI] 1.63−2.15) unadjusted for confounders, and OR of 1.87 (95% CI 1.63−2.15) when adjusted for the above confounders. Finally, steroid type was evaluated individually comparing risk of pneumonia or LRTI with fluticasone and betamethasone, with an OR of 1.20 (95% CI 1.06−1.35; p = 0.003) and OR of 1.64 (95% CI 1.50−1.79; p < 0.001), respectively. No other steroid inhalers were associated with an increased risk of pneumonia or LRTI.