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11-03-2010 | Respiratory | Article

ICS and LABA treatment not linked to pneumonia in COPD


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MedWire News: Treatment with inhaled corticosteroids (ICSs) and long-acting beta-agonists (LABAs), either alone or in combination, is not associated with a significantly increased risk for pneumonia in patients with chronic obstructive pulmonary disease (COPD), research shows.

Patients with COPD who have airflow obstruction and persistent daily symptoms are often prescribed LABAs and ICSs to improve lung function, reduce symptoms and maintain quality of life.

However, three recent studies have suggested that treatment with an ICS/LABA combination or ICSs alone may be associated with a small but significantly increased risk for pneumonia in COPD patients, explain Douglas Mapel (Lovelace Clinic Foundation, Albuquerque, New Mexico, USA) and team.

To investigate further, the researchers studied data on 5245 patients with COPD from three large regional managed care organizations in the USA. All the participants had used inhaled medications as part of their treatment.

In total, 2154 patients were diagnosed with pneumonia at least once between September 2001 and August 2003.

Analysis revealed that treatment with ICSs alone, LABAs alone or an ICS/LABA combination was not associated with a significantly increased risk for pneumonia compared with short-acting bronchodilator treatment.

However, the team notes that treatment with ICSs alone was associated with a non-significant 1.29-fold increased risk for pneumonia compared with short-acting bronchodilator treatment.

Factors associated with the greatest risk for pneumonia were older age and increased lung disease severity.

Mapel and team conclude in the Primary Care Respiratory Journal: “Treatment with ICSs or combination treatment with ICS/LABA was not associated with a substantially increased risk of diagnosed pneumonia among COPD patients treated in the general population. Any risk that might be attributed to ICS exposure appears to be very small in comparison to the pneumonia risk associated with older age or advanced lung disease.

They add: “The incidence of pneumonia was remarkably high among COPD patients in this population-based cohort, with or without inhaled treatments.

“Clinicians need to be cognizant of the proven benefits of treatment – improved lung function along with reduced chronic symptoms and acute exacerbations – in addition to the potential for side effects, and consider this balance in the context of COPD natural history.”

MedWire ( is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

By Mark Cowen

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