Inhaled corticosteroids increase pneumonia risk in asthma

Research from the UK indicates that the use of inhaled corticosteroids is independently associated with an increased risk for pneumonia and lower respiratory tract infection (LRTI) in patients with asthma.

The findings, reported in Chest, show that asthma patients who had pneumonia or LRTI were 24% more likely to have received a prescription for inhaled corticosteroids in the prior 90 days than were asthma patients without infection.

Overall, 3425 (49.9%) of 6857 patients with asthma who had pneumonia or LRTI had a recent prescription compared with 12,169 (33.5%) of their 36,312 age- and gender-matched controls with asthma.

Furthermore, the team from the University of Nottingham observed a dose-dependent relationship, such that those receiving inhaled corticosteroids over 1000 µg daily were 2.04 times more likely to have pneumonia or LRTI than were controls. This relationship was even stronger when the authors considered pneumonia alone, for which the risk increased 2.37-fold with high-dose corticosteroid use, while the risk for LRTI increased 1.75-fold.

“Our results suggest that the dose of [inhaled corticosteroid] prescribed should be kept to the minimum necessary and that the dose should be stepped down if the patient is well controlled,” say the authors, led by Dominick Shaw. They also note that it may be important for physicians to consider whether infection is responsible for recurrent symptoms before increasing the current dose of steroids.

An association between the use of inhaled corticosteroids and pneumonia in chronic obstructive pulmonary disease was recently reported, and asthma is a known risk factor for invasive pneumococcal disease, the team explains.

However, the mechanism by which steroids influence pneumonia risk and bacterial numbers in asthma is unknown.

“A review and meta-analysis of asthma studies involving [inhaled corticosteroids] and an exploration of the effect of [inhaled corticosteroids] on the lung microbiota are now required,” they conclude.

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