Inhaled corticosteroids 'up pneumonia risk by one third in lung disease sufferers'

Washington, Nov 26 : Widely used inhaled corticosteroid drugs increase risk of pneumonia by full third in people suffering from lung disease, according to a new study.

The risk associated with the use of anti-inflammatory medications has led Lung disease experts at Johns Hopkins to call for physicians to show much greater caution in prescribing inhaled corticosteroid drugs for people with chronic obstructive pulmonary disease (COPD).

Millions of people around the world, mostly former or current smokers, are living with so-called COPD, marked by the potentially fatal, lung-diminishing conditions of emphysema and chronic bronchitis.

The inhalers in question greatly relieve such symptoms as shortness of breath, wheezing, phlegm and physical exhaustion from light exercise.

And the call comes in line with the Hopkins team's review and analysis of adverse events recorded in 11 clinical studies that in total involved more than 14,000 men and women with COPD.

The review compared adverse events among those who took inhaled corticosteroids and others who did not.

In the report, researchers found that the increased risk mostly occurred in people taking the highest possible doses, such as 500 micrograms of fluticasone twice daily for a relatively short time (less than two years), whose lung function was 40 percent or lower than expected and who also combined their steroid therapy with bronchodilators, used to keep the airways open.

However, the researchers still don't know why the treatment increases risk of lung infection, but they suspect that the drugs suppress the immune system.

Despite the increased pneumonia risk, the team found no clear evidence that the drug therapy also pushes up rates for other steroid-related problems, such as bone fractures, nor was there an increase in deaths.

Senior study investigator and critical care specialist Eddy Fan, M.D., said the results of the analysis should not alarm patients or cause them to stop taking their medications but should spur physicians to screen and monitor their patients to find the lowest possible steroid dose that works, especially in the elderly, people with immune system problems, and people who have had multiple bouts of pneumonia and for whom repeat bacterial infection might be a life-threatening complication.

"Inhaled corticosteroids are not of equal benefit to all, and what we are seeing is that the treatment may be more harmful and pose a greater risk of harm to some," said Fan.

He added: "Physicians really need to strongly evaluate a patient's individual characteristics before prescribing these steroid medications, and patients, in turn, should weigh the risks and benefits of taking the drugs, despite their proven record in providing symptomatic relief."

Pulmonologist M. Brad Drummond, M.D., M.H.S., who led the study, said: "catching this bacterial infection can seriously disrupt quality of life, making it harder for COPD patients to breathe and possibly leading to hospitalization."

The study will appear online in the Journal of the American Medical Association.

ANI