Risk of pneumonia during long term regular treatment of stable COPD with inhaled glucocorticoids: a systematic review.

Abstract

Inhaled glucocorticoids are anti-inflammatory drugs used in combination with long acting bronchodilators beta2-agonists for the treatment of stable chronic obstructive pulmonary disease (COPD), to improve lung function and symptoms and to reduce the future risk COPD exacerbations. However, has been also associated to an increased risk of pneumonia. The objective of this systematic review was therefore to analyze all randomized controlled trials to identify the risk of pneumonia during the regular treatment with long-term inhaled glucocorticosteroids compared to treatment with placebo in patients with stable COPD. From a literature search on PubMed, 19 randomized, placebo-controlled, long term (at least 52-week) studies have been identified. The inhaled glucocorticoids administered were: budesonide (6 studies), mometasone furoate (3 studies), beclomethasone dipropionate (1 study), triamcinolone acetonide (1 study), fluticasone propionate (7 studies) and fluticasone furoate (1 study). Only 7 of the 19 trials identified in our systematic review reported data on pneumonia and only one study required radiological evidence for diagnosis. The incidence of pneumonia was slightly increased in patients treated with glucocorticoid inhaled compared to placebo in most studies, regardless of the type of glucocorticoid inhalation used, suggesting a class effect. Older age, low body mass index, low FEV1, being a smoker are all factors variously associated with increased risk of pneumonia.