Inhaled corticosteroids and incidence of pneumonia in chronic obstructive pulmonary disease (COPD) patients: A review

  • Yuda Anzas Mara Master of Clinical Pharmacy, Faculty of Pharmacy, Universitas Gadjah Mada
  • I Dewa Putu Pramantara S Department of Internal Medicine Division of Geriatrics FKKMK, Universitas Gadjah Mada
  • Zullies Ikawati Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Gadjah Mada
Keywords: inhaled corticosteroids, pneumonia, chronic obstructive pulmonary disease, safety, effectiveness

Abstract

Chronic obstructive pulmonary disease (COPD) is a worldwide respiratory disease that causes significant morbidity and mortality. The primary emphasis in managing COPD is on symptom control and preventing exacerbations. However, there has been ongoing discussion surrounding the safety of inhaled corticosteroids (ICS). This narrative review aimed to examine ICS influence on pneumonia in patients with COPD by consolidating findings from randomized controlled trials and observational studies. The data indicated that the utilization of ICS may be linked to a heightened susceptibility to pneumonia, with varying levels of risk reported across different ICS drugs. Regimens containing fluticasone were found to exhibit an increased susceptibility to pneumonia. The presence of a dose-dependent correlation between ICS and the incidence of pneumonia is apparent. Further investigation is necessary to clarify the fundamental principles and enhance treatment recommendations to maximize the management of COPD while minimizing the incidences of pneumonia associated with ICS.

References

GOLD. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease (2022 Report). Published online 2022.

Tamondong-Lachica DR, Skolnik N, Hurst JR, Marchetti N, Rabe APJ, Oca MMD, et al. GOLD 2023 Update: Implications for clinical practice. Int J Chron Obstruct Pulmon Dis 2023; 18:745-54.

https://doi.org/10.2147/COPD.S404690

Lipson DA, Barnhart F, Brealey N, Brooks J, Criner GJ, Day NC, et al. Once-Daily Single-Inhaler Triple versus Dual Therapy in Patients with COPD. N Engl J Med 2018; 378(18):1671-80.

https://doi.org/10.1056/NEJMoa1713901

Nannini LJ, Poole P, Milan SJ, Kesterton A. Combined corticosteroid and long‐acting beta(2)‐agonist in one inhaler versus inhaled corticosteroids alone for chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2013; 2013(8):CD006826.

https://doi.org/10.1002/14651858.CD006826.pub2

Battaglia S, Cardillo I, Lavorini F, Spatafora M, Scichilone N. Erratum to: Safety considerations of inhaled corticosteroids in the elderly. Drugs Aging 2015; 32(12):1067-76.

https://doi.org/10.1007/s40266-015-0320-7

Ruby D. The impact of community-acquired pneumonia on acute exacerbation of chronic obstructive pulmonary disease patients as regards in-hospital complications and early readmission. Open Respir Med J 2020; 14:10-15.

https://doi.org/10.2174/1874306402014010010

Lee EG, Kim Y, Hwang YI, Yoo KH, Lee SE, Jung KY, et al. Comparison of pneumonia incidence between long-acting muscarinic antagonist and inhaled corticosteroid plus long-acting beta agonist in patients with COPD. Sci Rep 2023; 13(1):8183.

https://doi.org/10.1038/s41598-023-35223-3

Cheng SL, Su KC, Wang HC, Perng DW, Yang PC. Chronic obstructive pulmonary disease treated with inhaled medium- or high-dose corticosteroids: a prospective and randomized study focusing on clinical efficacy and the risk of pneumonia. Drug Des Devel Ther 2014; 8:601-7.

https://doi.org/10.2147/DDDT.S63100

Leitao Filho FS, Takiguchi H, Akata K, Ra SW, Moon JY, Kim HK, et al. Effects of inhaled corticosteroid/long-acting β2-agonist combination on the airway microbiome of patients with chronic obstructive pulmonary disease: A randomized controlled clinical trial (DISARM). Am J Respir Crit Care Med 2021; 204(10):1143-52.

https://doi.org/10.1164/rccm.202102-0289OC

Martinez FJ, Boscia J, Feldman G, Scott-Wilson C, Kilbride S, Fabbri L, et al. Fluticasone furoate/vilanterol (100/25; 200/25 μg) improves lung function in COPD: A randomised trial. Respir Med 2013; 107(4):550-9.

https://doi.org/10.1016/j.rmed.2012.12.016

Ohar JA, Crater GD, Emmett A, Ferro TJ, Morris AN, Raphiou I, et al. Fluticasone propionate/salmeterol 250/50 μg versus salmeterol 50 μg after chronic obstructive pulmonary disease exacerbation. Respir Res 2014; 15(1):105.

https://doi.org/10.1186/s12931-014-0105-2

Rossi A, Van Der Molen T, Del Olmo R, Papi A, Wehbe L, Quinn M, et al. INSTEAD: A randomised switch trial of indacaterol versus salmeterol/fluticasone in moderate COPD. Eur Respir J 2014; 44(6):1548-56.

https://doi.org/10.1183/09031936.00126814

Wedzicha JA, Banerji D, Chapman KR, Vestbo J, Roche N, Ayers RT, et al. Indacaterol-glycopyrronium versus salmeterol-fluticasone for COPD. N Engl J Med 2016; 374(23):2222-34.

https://doi.org/10.1056/NEJMoa1516385

Wedzicha JA, Zhong N, Ichinose M, Humphries M, Fogrl R, Thach C, et al. Indacaterol/glycopyrronium versus salmeterol/fluticasone in Asian patients with COPD at a high risk of exacerbations: results from the FLAME study. Int J Chorn Obstruct Pulmon Dis 2017; 12:339-49.

https://doi.org/10.2147/COPD.S125058

Tashkin DP, Miravitlles M, Celli BR, Metzdorf N, Mueller A, Halpin DMG, et al. Concomitant inhaled corticosteroid use and the risk of pneumonia in COPD: a matched-subgroup post hoc analysis of the UPLIFT® trial. Respir Res 2018; 19(1):196.

https://doi.org/10.1186/s12931-018-0874-0

Yawn BP, Li Y, Tian H, Zhang J, Arcona S, Kahler KH. Inhaled corticosteroid use in patients with chronic obstructive pulmonary disease and the risk of pneumonia: A retrospective claims data analysis. Int J Chron Obstuct Pulmon Dis 2013; 8:295-304.

https://doi.org/10.2147/COPD.S42366

DiSantostefano RL, Sampson T, Van Le H, Hinds D, Davis KJ, Bakerly ND. Risk of pneumonia with inhaled corticosteroid versus long-acting bronchodilator regimens in chronic obstructive pulmonary disease: a new-user cohort study. PLoS ONE 2014; 9(5):e97149.

https://doi.org/10.1371/journal.pone.0097149

Morjaria JB, Rigby A, Morice AH. Inhaled corticosteroid use and the risk of pneumonia and COPD exacerbations in the UPLIFT study. Lung 2017; 195(3):281-8.

https://doi.org/10.1007/s00408-017-9990-8

Lee JH, Park YH, Kang DR, Lee SJ, Lee MK, Kim SH, et al. Risk of pneumonia associated with inhaled corticosteroid in patients with chronic obstructive pulmonary disease: A Korean population-based study. Int J Chron Obstuct Pulmon Dis 2020; 15:3397-406.

https://doi.org/10.2147/COPD.S286149

Lee EG, Kim Y, Hwang YI, Yoo KH, Lee SE, Jung KY, et al. Comparison of pneumonia incidence between long-acting muscarinic antagonist and inhaled corticosteroid plus long-acting beta agonist in patients with COPD. Sci Rep 2023; 13(1):8183.

https://doi.org/10.1038/s41598-023-35223-3

Park JW, Hong Y, Rhee CK, Choi HS, Kimm K, Yoo KH, et al. The impact of inhaled corticosteroids on the prognosis of chronic obstructive pulmonary disease. Int J Chron Obstuct Pulmon Dis 2023; 18:733-43.

https://doi.org/10.2147/COPD.S388367

Wang CY, Lai CC, Yang WC, Lin CC, Chen L, Wang HC, et al. The association between inhaled corticosteroid and pneumonia in COPD patients: the improvement of patients’ life quality with COPD in Taiwan (IMPACT) study. Int J Chron Obstuct Pulmon Dis 2016; 11(1):2775-83.

https://doi.org/10.2147/COPD.S116750

Cascini S, Kirchmayer U, Belleudi V, Bauleo L, Pistelli R, Martino MD, et al. Inhaled corticosteroid use in chronic obstructive pulmonary disease and risk of pneumonia: a nested case-control population-based study in Lazio (Italy)-The OUTPUL Study. COPD 2017; 14(3):311-7.

https://doi.org/10.1080/15412555.2016.1254172

Hirano R, Fujita M, Matsumoto T, On R, Watanabe K. Inhaled corticosteroids might not increase the risk of pneumonia in patients with chronic obstructive pulmonary disease in Japan. Int J Chron Obstuct Pulmon Dis 2018; 13:3503-9.

https://doi.org/10.2147/COPD.S180349

Barnes PJ. How corticosteroids control inflammation: Quintiles prize lecture 2005. Br J Pharmacol 2006; 148(3):245-54.

https://doi.org/10.1038/sj.bjp.0706736

Su YC, Jalalvand F, Thegerström J, Riesbeck K. The interplay between immune response and bacterial infection in COPD: Focus upon non-typeable Haemophilus influenzae. Front Immunol 2018; 9:2530.

https://doi.org/10.3389/fimmu.2018.02530

Festic E, Scanlon PD. Incident pneumonia and mortality in patients with chronic obstructive pulmonary disease. A double effect of inhaled corticosteroids? Am J Respir Crit Care Med 2015; 191(2):141-8.

https://doi.org/10.1164/rccm.201409-1654PP

Janson C, Stratelis G, Miller-Larsson A, Harrison TW, Larsson K. Scientific rationale for the possible inhaled corticosteroid intraclass difference in the risk of pneumonia in COPD. Int J Chron Obstruct Pulmon Dis 2017; 12:3055-64.

https://doi.org/10.2147/COPD.S143656

Published
2025-01-09
Section
Articles