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Inhaled corticosteroids and the risk of pneumonia in people with asthma

McKeever, Tricia M.; Harrison, Timothy W.; Hubbard, Richard; Shaw, Dominick E.

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Authors

TRICIA MCKEEVER tricia.mckeever@nottingham.ac.uk
Professor of Epidemiology and Medical Statistics

Timothy W. Harrison

RICHARD HUBBARD richard.hubbard@nottingham.ac.uk
Blf/Gsk Professor of Epidemiological Resp Research

Dominick E. Shaw



Abstract

Background

In clinical trials, the use of inhaled corticosteroids is associated with an increased risk of pneumonia in people with COPD, but whether the same is true for people with asthma is not known.
Methods

With the use of primary care data from The Health Improvement Network, we identified people with asthma, and from this cohort, we identified patients with pneumonia or lower respiratory tract infection and age- and sex-matched control subjects. Conditional logistic regression was used to determine the association between the dose and type of inhaled corticosteroid and the risk of pneumonia or lower respiratory tract infection.
Results

A dose-response relationship was found between the strength of inhaled corticosteroid dose and risk of pneumonia or lower respiratory tract infection (P < .001 for trend) such that after adjusting for confounders, people receiving the highest strength of inhaled corticosteroid (? 1,000 ?g) had a 2.04 (95% CI, 1.59-2.64) increased risk of pneumonia or lower respiratory tract infection compared with those with asthma who did not have a prescription for inhaled corticosteroids within the previous 90 days.
Conclusions

People with asthma receiving inhaled corticosteroids are at an increased risk of pneumonia or lower respiratory infection, with those receiving higher doses being at greater risk. Pneumonia should be considered as a possible side effect of inhaled corticosteroids, and the lowest possible dose of inhaled corticosteroids should be used in the management of asthma.

Journal Article Type Article
Acceptance Date Jul 31, 2013
Online Publication Date Dec 28, 2015
Publication Date Dec 1, 2013
Deposit Date Nov 2, 2016
Publicly Available Date Nov 2, 2016
Journal Chest
Print ISSN 0012-3692
Electronic ISSN 1931-3543
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 144
Issue 6
DOI https://doi.org/10.1378/chest.13-0871
Public URL https://nottingham-repository.worktribe.com/output/1000638
Publisher URL http://www.sciencedirect.com/science/article/pii/S001236921548688X

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