Patients with Chronic Obstructive Pulmonary Disease (COPD) should be careful about the inhalers they use. A new study has found that a popular class of anti-inflammatory inhalers, after prolonged usage, could considerably hike the risk of pneumonia in these patients.
COPD is a progressive disease that makes it hard to breathe and is characterised by coughing that produces large amounts of mucus, wheezing, shortness of breath, chest tightness and other symptoms.
The research by Wake Forest University School of Medicine scientists mainly deals with the incidence of pneumonia in COPD patients, who were exposed to inhaled corticosteroid drugs, either alone or in combination with other drugs.
While inhaled corticosteroids, used alone or in combination with other drugs for the treatment of asthma, have not been approved for use in patients with COPD, it has been suggested in combination with beta-antagonists, which dilate the lungs.
The available inhaled steroid combinations are fluticasone/salmeterol, marketed byGlaxoSmithKline as AdvairTM, and budesonide/formoterol, marketed by AstraZeneca as SymbicortTM.
Although, the inhalers can successfully relieve many of the symptoms of COPD, they have been linked with an increased risk of pneumonia in recent studies.
In the current study, researchers reviewed 18 randomized clinical trials, several of which were unpublished, involving nearly 17,000 patients in total.
They compared the incidence of pneumonia in patients who had taken inhaled corticosteroids for at least 24 weeks versus patients who had taken a placebo, or patients who had taken combination inhaled corticosteroids and long-acting beta-antagonists versus patients who took only the long-acting bronchodilator.
After the analysis it was found that inhaled corticosteroid use, alone or in combination with bronchodilators, for at least 24 weeks was associated with a significantly increased risk of pneumonia and serious pneumonia (60 to 70 percent increase).
However, it was not associated with an increased risk of death.
Thus, one can say that one in every 47 patients with COPD using a corticosteroid inhaler for one year is likely to develop pneumonia linked to use of the drug.
"Our robust meta-analysis ... clarifies that the risk of pneumonia reported as a serious adverse event, can be specifically attributed to the long-term use of the inhaled steroid component," the researchers wrote in their report.
Researchers advised that these results pertain specifically to COPD patients rather than asthma patients, and recommend that "clinicians should remain vigilant for the development of pneumonia with inhaled corticosteroids, as the signs and symptoms of pneumonia may closely mimic that of COPD exacerbations."
The study appears in this month's issue of Archives of Internal Medicine.