TY - JOUR
T1 - Inhaled corticosteroids and the risk of pneumonia in people with asthma
T2 - A case-control study
AU - McKeever, Tricia
AU - Harrison, Timothy W.
AU - Hubbard, Richard
AU - Shaw, Dominick
N1 - Funding Information:
Financial/nonfinancial disclosures: The authors have reported to CHEST the following conflicts of interest: Dr Harrison has received financial support from Boehringer Ingelheim GmbH and GlaxoSmithKline to attend scientific meetings and honorarium payments for advisory boards from GlaxoSmithKline, Napp Pharmaceuticals Limited, and Boehringer Ingelheim GmbH. Dr Hubbard has two Medical Research Council grants to investigate the causes and natural history of lung fibrosis and a Roy Castle clinical fellowship award to study care pathways for people with lung cancer. Dr Hubbard is the current GlaxoSmithKline/British Lung Foundation Professor of Respiratory Epidemiology. GlaxoSmithKline has cofunded a cohort study of lung biomarkers for people with idiopathic pulmonary fibrosis for which Dr Hubbard is a coapplicant. Drs McKeever and Shaw have reported that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.
PY - 2013/12
Y1 - 2013/12
N2 - Background: In clinical trials, the use of inhaled corticosteroids is associated with an increased risk of pneumonia in people with COPD, but whether the same is true for people with asthma is not known. Methods: With the use of primary care data from The Health Improvement Network, we identifi ed people with asthma, and from this cohort, we identified patients with pneumonia or lower respiratory tract infection and age- and sex-matched control subjects. Conditional logistic regression was used to determine the association between the dose and type of inhaled corticosteroid and the risk of pneumonia or lower respiratory tract infection. Results: A dose-response relationship was found between the strength of inhaled corticosteroid dose and risk of pneumonia or lower respiratory tract infection ( P<.001 for trend) such that after adjusting for confounders, people receiving the highest strength of inhaled corticosteroid (≥ 1,000 μg) had a 2.04 (95% CI, 1.59-2.64) increased risk of pneumonia or lower respiratory tract infection compared with those with asthma who did not have a prescription for inhaled corticosteroids within the previous 90 days. Conclusions: People with asthma receiving inhaled corticosteroids are at an increased risk of pneumonia or lower respiratory infection, with those receiving higher doses being at greater risk. Pneumonia should be considered as a possible side effect of inhaled corticosteroids, and the lowest possible dose of inhaled corticosteroids should be used in the management of asthma.
AB - Background: In clinical trials, the use of inhaled corticosteroids is associated with an increased risk of pneumonia in people with COPD, but whether the same is true for people with asthma is not known. Methods: With the use of primary care data from The Health Improvement Network, we identifi ed people with asthma, and from this cohort, we identified patients with pneumonia or lower respiratory tract infection and age- and sex-matched control subjects. Conditional logistic regression was used to determine the association between the dose and type of inhaled corticosteroid and the risk of pneumonia or lower respiratory tract infection. Results: A dose-response relationship was found between the strength of inhaled corticosteroid dose and risk of pneumonia or lower respiratory tract infection ( P<.001 for trend) such that after adjusting for confounders, people receiving the highest strength of inhaled corticosteroid (≥ 1,000 μg) had a 2.04 (95% CI, 1.59-2.64) increased risk of pneumonia or lower respiratory tract infection compared with those with asthma who did not have a prescription for inhaled corticosteroids within the previous 90 days. Conclusions: People with asthma receiving inhaled corticosteroids are at an increased risk of pneumonia or lower respiratory infection, with those receiving higher doses being at greater risk. Pneumonia should be considered as a possible side effect of inhaled corticosteroids, and the lowest possible dose of inhaled corticosteroids should be used in the management of asthma.
UR - http://www.scopus.com/inward/record.url?scp=84890289336&partnerID=8YFLogxK
U2 - 10.1378/chest.13-0871
DO - 10.1378/chest.13-0871
M3 - Article
C2 - 23990003
AN - SCOPUS:84890289336
SN - 0012-3692
VL - 144
SP - 1788
EP - 1794
JO - Chest
JF - Chest
IS - 6
ER -
