Treatment of COPD with inhaled corticosteroids (ICS) may decrease the risk of dying from pneumonia and from other causes despite being associated with an increase in the occurrence of pneumonia, according to a new meta-analysis presented at the 2015 American Thoracic Society International Conference.
"Our systematic review and meta-analysis of 38 studies echoes individual studies which have shown that while ICS use may increase the risk of pneumonia in COPD patients, it lowers the risk of both pneumonia-associated and overall mortality," said lead author Ena Gupta, MD, MPH, of the University of Florida College of Medicine. "This benefit may be due to the immunosuppressive and anti-inflammatory effects of ICS treatment."
The study included data from 29 randomized controlled trials and nine observational studies. In both randomized and observational studies, ICS use was associated with an increased risk of pneumonia in analyses that were not adjusted for possible confounding factors. In six randomized trials, ICS use was not associated with an increase in pneumonia-associated mortality, and in seven observational studies, it was associated with a significant decrease.
Similar patterns were observed for all-cause mortality, with no increase in overall mortality seen in 29 randomized trials, and a significant decrease seen in six observational studies.
"The increase in pneumonia incidence seen with ICS treatment for COPD appears to be counterbalanced by a decrease in mortality," said Dr. Gupta. "This data can be used to weigh the overall risks and benefits of ICS use in COPD patients."
A prospective study of antibiotic use and clinical factors in patients with suspected pneumonia