Inhaled corticosteroids in COPD have neutral effect on mortality despite increased pneumonia risk

The use of inhaled corticosteroids (ICS) in patients with chronic obstructive pulmonary disease (COPD) is associated with an increased risk of pneumonia but a neutral or even reduced risk of pneumonia-associated and overall mortality, results of a meta-analysis indicate.

Previous studies have suggested that ICS have immunosuppressant and potent anti-inflammatory effects, which the researchers say may explain their overall impact on mortality in patients with COPD.

“Although ICS might predispose COPD patients to the increased risk of pneumonia, their anti-inflammatory and/or other mitigating effect might paradoxically counterbalance this risk and result in similar or possibly improved mortality,” says Ena Gupta, the study’s lead author, from University of Florida College of Medicine.

The research was presented at the 2015 American Thoracic Society International Conference^[1]
, held in Denver, Colorado.

Gupta’s group performed a literature review of randomised controlled trials and observational studies of patients with COPD using ICS, published since the late 1990s.

Their meta-analysis, which included 38 relevant studies, found that the unadjusted risk of pneumonia was increased in patients using ICS, with relative risks (RR) ranging from 1.61 in randomised controlled trials (95% confidence interval [CI] 1.35-1.93) to 1.89 in observational studies (95% CI 1.39-2.59).

By contrast, overall and pneumonia-associated mortality were apparently unaffected or reduced by ICS use: RRs ranged from 0.79 (95% CI 0.65-0.97) to 0.95 (95% CI 0.85-1.05) for overall mortality, and from 0.72 (95% CI 0.59-0.88) to 0.91 (95% CI 0.52-1.59) for pneumonia-associated mortality. However, there was significant heterogeneity among studies, the researchers note.