ICS Use in COPD Associated With Lower Pneumonia-Related, Overall Mortality

Treatment with inhaled corticosteroids (ICS) in patients with chronic obstructive pulmonary disease (COPD) may reduce the risk of death from pneumonia and other causes although they are associated an increased incidence of pneumonia, a meta-analysis presented at the 2015 American Thoracic Society International Conference has shown.

The systematic review and meta-analysis supported the overall notion that ICS treatment in COPD patients lowers the risk of pneumonia-associated and overall mortality despite the increased risk of pneumonia with ICS use. Ena Gupta, MD, MPH, from the University of Florida College of Medicine added that the benefit of ICS therapy “may be due to the immunosuppressive and anti-inflammatory effects.”

The study evaluated data from 29 randomized controlled trials and nine observational studies. Findings showed that ICS use was related to an increased risk of pneumonia in analyses that did not adjust for possible confounding factors. Six randomized trials showed that ICS use was not linked to an increase in pneumonia-associated mortality (RR 0.91, 95% CI: 0.52–1.59; P=0.74); seven observational studies showed a significant decrease in pneumonia-associated mortality (OR 0.72; 95% CI 0.59–0.88; P=0.001). Rates of all-cause mortality were similar across the studies, with no increased risk in 29 randomized trials, and a significant decrease in six observational studies.

Researchers concluded that though ICS treatment predisposes COPD patients to an increased risk of incident pneumonia, it appears to have a countering benefit on mortality resulting in no net change, or possibly a slight improvement in mortality.

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