Inhaler use seen raising illness risk: pneumonia 34% more likely with steroid treatment

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Inhaler use seen raising illness risk

JHU study finds pneumonia 34% more likely with steroid treatment

By Brewington | kelly.brewington@...

November 26, 2008

http://www.baltimoresun.com/news/health/bal-md.inhalers26nov26,0,7376992.story

Researchers at the s Hopkins University are urging doctors to use

caution when prescribing steroid inhalers to treat a common - and

sometimes fatal - lung disease after a study found they increased the

risk of pneumonia in some patients by 34 percent.

About half of all patients with chronic obstructive pulmonary disease,

or COPD, use steroid inhalers to ease the wheezing and breathlessness

caused by the condition.

Although medical experts have known for years that inhalers are

effective in treating symptoms, doctors have raised questions about side

effects and whether they help people live longer, said Dr. M. Bradley

Drummond, a pulmonologist at the Hopkins School of Medicine and the

study's lead author.

" Because these agents are so effective at controlling symptoms, we do

feel there is a good role for inhaled steroids for treating COPD, " he

said. " But for some patients, there may be more harm than benefits. "

The study, which appears in this week's Journal of the American Medical

Association, also found that while the inhalers helped, they did not

extend a patient's life after one year of use.

An estimated 10 million to 15 million Americans have COPD, which

encompasses emphysema and chronic bronchitis. The disease, which is most

often caused by smoking, is the nation's fourth-leading cause of death.

It is characterized by shortness of breath, extra phlegm, wheezing and

an inability to tolerate light exercise or even walking up a flight of

stairs. Inhaled steroids, sold under brand names such as Advair and

Pulmicort, help by decreasing the amount of inflammation, or swelling,

in the lungs.

In Baltimore, where 28 percent of people reportedly smoke - the national

average is 21 percent - an estimated 25,000 people have COPD, Drummond said.

The study examined 11 clinical trials, including 14,426 patients.

Investigators compared the incidence of pneumonia in those who used

inhalers with the incidence of those who did not.

Experts are not sure why inhalers appeared to increase the risk of

pneumonia, but they believe they may weaken a person's immune system.

Drummond said the risk of pneumonia appeared to increase in people with

worse lung function and those who took the highest dose of steroids. But

such patients represented too small a group for researchers to say for

certain, he said.

Patients who use the inhalers should not stop, Drummond advised. Rather,

they should talk with their doctors if they have concern.

There is no cure for COPD, and treatments are limited. Some people can

benefit from other types of inhalers, which relax the muscles around the

airways, and oxygen therapy. For patients who smoke, the most important

step they can take is to stop, Drummond said.

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*Inhaled Corticosteroids in Patients With Stable Chronic Obstructive

Pulmonary Disease: A Systematic Review and Meta-analysis*

M. Bradley Drummond, MD, MHS et al.

JAMA. 2008;300(20):2407-2416

http://jama.ama-assn.org/cgi/content/full/300/20/2407

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