NEW YORK (Reuters Health) – When patients with chronic obstructive pulmonary disease (COPD) come down with community-acquired pneumonia, whether or not they use inhaled corticosteroids has no effect on their recovery, British investigators report.
In this prospective, observational study, the authors say, even the sickest patients on inhaled corticosteroids (ICS) were no more or less likely to develop complications or to die.
Previous research has suggested that chronic ICS use in COPD may raise the risk of pneumonia but protect against pneumonia-related complications.
To test this theory, Dr. Aran Singanayagam and colleagues at the Royal Infirmary of Edinburgh studied 490 adults with spirometry-confirmed COPD diagnosed with community-acquired pneumonia between 2005 and 2009.
About three-quarters of the patients (n = 376) had been using ICS for at least a month prior to hospitalization – budesonide (alone or with formoterol), fluticasone (alone or with salmeterol), beclomethasone or ciclesonide.
According to their report in the European Respiratory Journal online March 23rd, the researchers found no significant baseline differences in pneumonia severity between ICS users and their counterparts, although ICS users had more severe COPD.
All the same, mortality rates at 30 days (12.0% in ICS users vs 8.9% in non-users) and at 6 months (18.4% vs 14.9%, respectively) were similar between groups.
Results also showed no significant differences in need for mechanical ventilation, inotropic support, or both; or development of complicated parapneumonic effusion, empyema or pulmonary abscess. In both groups, median time to clinical stability was 3 days and median length of hospital stay was 6 days.
The similarities in outcomes were still apparent in multivariable analysis, overall and among the 39 patients admitted to the intensive care unit and those with the most severe pneumonia.
Thus, their data do not support the hypothesis that chronic ICS use imparts protection against pneumonia complications. Dr. Singanayagam’s team suggests that methodological differences may account for differences between their studies and those of others. For example, one large study based diagnoses on ICD-9 codes, whereas the current research clinically and radiographically confirmed the presence of COPD and community-acquired pneumonia.
Still, they say, independent validation of their findings is required.
Eur Resp J
