Researchers examined the association between inhaled corticosteroid treatment and in-hospital mortality from pneumonia in patients with chronic obstructive pulmonary disease, and found that long-acting inhaled bronchodilators (IBD) therapy combined with corticosteroids was associated with lower mortality from pneumonia than treatment with IBD alone.
The research paper, “Effect of outpatient therapy with inhaled corticosteroids on decreasing in-hospital mortality from pneumonia in patients with COPD,” was published in the International Journal of Chronic Obstructive Pulmonary Disease.
Inhaled corticosteroids (ICS) and long-acting inhaled bronchodilators (IBD) are considered beneficial for the management of chronic obstructive pulmonary disease (COPD). However, the benefits of ICS have been questioned, particularly due to reports of unwanted side effects, namely the increase of the risk of pneumonia in these patients. It is therefore important to clarify the association between ICS and mortality from pneumonia in these patients.
Using a Japanese national database, the researchers collected data from 1,165 hospitals. The 7,033 eligible COPD patients that had been admitted with pneumonia were divided into those who received ICS with IBD as therapy, and those who received IBD alone. In this patient population, 3,331 patients received IBD, and 3,702 received combination therapy.
Patients in the IBD-only group were more likely to be older, have a lower body mass index, worse overall state and more severe pneumonia, compared to patients in the combination treatment group. In-hospital mortality was 13.2% for the IBD-only group and 8.1% for those given ICS and IBD in combination. Researchers believe the study suggests that ICS may have protective effects against pneumonia and pneumonia-related mortality in patients with COPD due to its anti-inflammatory effects.
Previous studies have reported that ICS reduces bacterial invasion in the airways and has the potential to reduce inflammation. As such, prior use of ICS may lead to a less severe form of pneumonia. Here, the researchers also found that higher mortality was associated with some patients’ characteristics, namely older age, male gender, more severe pneumonia and overall poorer health status.
Despite some study limitations, the researchers concluded that “Outpatient inhaled therapy with ICS and IBD was associated with lower mortality from pneumonia in patients with COPD than IBD treatment alone. ICS may have protective effects against pneumonia and help prevent pneumonia-related mortality in patients with COPD.”