Inhaled steroids up pneumonia risk in lung ailment
December 5th, 2008
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By Will Dunham
WASHINGTON (Reuters) - People with the lung ailment chronic obstructive pulmonary disease are more likely to get pneumonia if they use inhaled corticosteroid drugs and doctors should be more cautious in prescribing them, researchers said.
People with smoking-related chronic obstructive pulmonary disease, or COPD, who took the drugs for symptoms such as cough, wheezing, shortness of breath and exhaustion from light exercise were 34 percent more likely to develop pneumonia than those who did not, according to a study published on Tuesday.
COPD includes emphysema and chronic bronchitis.
Writing in the Journal of the American Medical Association, Dr. Brad Drummond of Johns Hopkins University in Baltimore and colleagues pooled the results of 11 previously published studies involving more than 14,000 COPD patients.
The patients used drugs including AstraZeneca Plc’s Pulmicort, or budesonide; Abbott Laboratories’ Azmacort, or triamcinolone; GlaxoSmithKline’s Flovent, or fluticasone, and Advair, which combines the corticosteroid Flovent with a long-acting beta-agonist.
“For physicians, the message from our study is that they should evaluate a patient’s individual characteristics before prescribing inhaled steroids,” Drummond said in a telephone interview.
“If a patient is burdened by significant symptoms such as shortness of breath, cough or exercise intolerance, previous studies have shown that inhaled steroids are quite effective. However, if a patient has relatively few symptoms or if a lung infection would be potentially life threatening, then inhaled steroids may be of more harm than benefit,” he said.
The COPD patients at especially high risk for pneumonia included those with the poorest lung function — less than 40 percent of what it should be — as well as those using the highest dose of inhaled steroids and those who used the drugs combined with other inhaled medications.
“However, this should not compel patients to stop taking their inhaled steroids,” Drummond added.
But COPD patients should speak with their doctor about the benefits and risks of inhaled steroids, Drummond said.
“Inhaled corticosteroids are not of equal benefit to all and what we are seeing is that the treatment may be more harmful and pose a greater risk of harm to some,” said Dr. Eddy Fan of Johns Hopkins, another of the researchers.
The researchers said the reason the drugs raise the risk of pneumonia is unclear but they may suppress the immune system.
COPD, typically caused by cigarette smoking, refers to a group of incurable and irreversible chronic lung ailments in which the airways in the lungs are obstructed. It is a leading cause of death globally and the fourth-leading cause of death in the United States.
The study also found that COPD patients who take these drugs are no more or less likely to die than those who do not. They also have no greater risk of bone fractures, which had been a concern because certain oral steroids are known to increase of osteoporosis and fracture risk.
(Editing by Julie Steenhuysen and Bill Trott)
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