Pneumonia Risk Up with Corticosteroids for COPD

(November 26, 2008) - The use of corticosteroids for treating chronic obstructive pulmonary disease (COPD) doesn't appear to help a lot and it may also be dangerous. (Read about "Chronic Obstructive Pulmonary Disease") An analysis of randomized trials indicates that use of inhaled corticosteroids for the treatment of COPD does not improve the rate of survival after one year, but is associated with an increased risk of pneumonia. (Read about "Pneumonia") That's the conclusion of a study in the Journal of the American Medical Association.

COPD is a lung disease characterized by recurrent episodes of coughing and breathlessness. It affects 10-15 million persons in the United States. COPD is currently the fourth leading cause of death in the United States, accounting for 120,000 deaths annually, and is expected to be the third leading cause of death by 2020, according to background information in the article. No drug and few interventions, other than smoking cessation (Read about "Quit Smoking") and supplemental oxygen, have been shown to improve the rate of death in patients with COPD. Recent studies regarding the use of inhaled corticosteroid (ICS) therapy for managing stable COPD have yielded conflicting results regarding survival and risk of adverse events.

Researchers conducted a review and meta-analysis of 11 randomized controlled trials (14,426 participants) to determine associations of ICS use of 6 or more months' duration with all-cause death and risk of pneumonia in patients with stable COPD.

All-cause mortality at 1-year follow-up was reported in five studies (9,233 patients), and analysis indicated that ICS therapy was not associated with a decreased risk of death after one year. There were 128 deaths among 4,636 individuals in the treatment group, and 148 deaths among 4,597 individuals in the control group.

Seven studies (10,776 patients) reported pneumonia outcomes, and indicated that patients receiving ICS had a 34 percent higher incidence of pneumonia. These studies included 777 events among 5,405 individuals in the treatment group and 561 events among 5,371 individuals in the control group.

"The association of ICS therapy with increased rates of pneumonia reported in our meta-analysis should be considered by clinicians and guideline developers when evaluating the role of ICS therapy in the management of stable COPD. This finding must be balanced with those of other reports describing beneficial effects of ICS therapy," the authors write.