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28-02-2013 | Respiratory | Article

Inhaled steroids may increase S. pneumoniae infection risk


Free abstract

medwireNews: Children with asthma who regularly use inhaled corticosteroids (ICS) are at significantly increased risk for oropharyngeal colonization by Streptococcus pneumonia, research suggests.

Linjie Zhang (Federal University of Rio Grande, Brazil) and colleagues found that the risk for oropharyngeal S. pneumonia colonization was almost four times greater in asthmatic children taking ICSs than in those with the respiratory condition who were not exposed to these medications.

"Given that naso-oropharyngeal colonization is an obligatory first step for S. pneumonia infections, the findings of this study may provide some clues about a possible link between use of ICS and risk of pneumococcal respiratory infections in children with persistent asthma," the researchers comment in Respirology.

The team studied 192 children with asthma, aged an average of 6 years, who attended a pediatric pulmonary clinic in Brazil. Of these, 96 had been taking daily ICS for at least 30 days (mean duration 8.6 months) at an average daily dose of beclomethasone 400 µg or equivalent, while the remaining 96 children had not been exposed to ICS.

Examination of oropharyngeal samples from the children revealed that the prevalence of S. pneumonia was higher in the group taking ICS than in the nonexposed group, at 27.1% versus 8.3%.

After accounting for factors such as age, gender, number of siblings, day-care/school attendance, concomitant use of intranasal steroids, vaccination against S. pneumonia, antibiotic use in the last 3 months, and hospitalization in the last 6 months, the team found that regular ICS use was a significant independent predictor of oropharyngeal S. pneumonia colonization, at an adjusted prevalence ratio of 3.75.

Zhang et al conclude: "This is the first study showing that children with persistent asthma taking daily ICS are nearly four times as likely to have oropharyngeal colonization by S. pneumonia as children with asthma not receiving ICS."

They add: "Further larger prospective studies are needed to better define the relationship between ICS therapy, oropharyngeal colonization by potential respiratory pathogens and clinical outcomes of these patients.

"The influence of doses of ICS, duration of treatment, type of ICS and type of delivery device is also needed to be investigated."

medwireNews ( is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2013

By Mark Cowen, Senior medwireNews Reporter

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