Steroid Inhalers Raise Pneumonia Risk for Lung Disease Patients
TUESDAY Nov. 25, 2008 -- A new review of existing data confirms that some common inhalers don't boost the life spans of people with the lung disease known as chronic obstructive pulmonary disease (COPD).
In fact, these medicines may even raise the risk of pneumonia in patients with COPD, the fourth biggest killer in the United States.
But patients shouldn't stop using the inhalers without consulting their doctors first, because the devices still provide benefit in some cases, said review lead author Dr. M. Bradley Drummond.
"It's about balancing the known benefits with potential risks," said Drummond, a fellow in the division of pulmonary and critical care medicine at Johns Hopkins University, Baltimore.
The study was published in the Nov. 26 issue of the Journal of the American Medical Association.
Chronic obstructive pulmonary disease -- which encompasses emphysema and chronic bronchitis -- follows heart disease, cancer and stroke as the leading cause of deaths among Americans, Drummond said. Symptoms include breathlessness, frequent wheezing and coughing. Treatment can ease symptoms, but there is no cure for COPD.
More than 90 percent of cases are related to smoking, Drummond said. Smoke causes abnormal inflammation in the lungs, which destroys the ends of the airways and makes it difficult for the body to extract the oxygen from the air around them, he said.
In many cases, patients can extend their lives by stopping smoking and breathing oxygen. Some turn to inhaled corticosteroids, which reduce inflammation by calming the immune system.
Inhaled corticosteroids, known by brand names such as Pulmicort, Azmacort and Flovent, are commonly used to treat lung conditions like asthma.
But research has suggested that the inhalers aren't right for all COPD patients. In the new review, Drummond and colleagues examined 11 studies and combined their results in a "meta analysis."
The researchers found no significant difference in the one-year death rate from research involving more than 4,600 patients who used the inhalers versus a similar number of patients who did not.
More patients were included in studies that examined the risk of pneumonia, however. The number of pneumonia of cases was about a third higher in those who used the inhalers compared to those who didn't.
A total of 777 of the 5,405 patients who used the inhalers developed pneumonia, compared to 561 of 5,371 patients who did not, the Johns Hopkins team noted.
Up to 15 million Americans currently have some form of COPD, Drummond said, "and it's estimated that about half of those use inhaled steroids. You're looking at six million people who may be exposed to this 34 percent increase in risk."
While there's "clearly a benefit in some patients" who report that they feel better while using inhalers, the drugs aren't for everyone, Drummond said.
It's not clear why the inhalers may boost the risks of pneumonia, he said, but they may suppress the immune system in the lungs.
Dr. Norman H. Edelman, chief medical officer of the American Lung Association, said the review reflects existing beliefs about the use of these devices
"We already have accepted that inhaled steroids increase the risk of pneumonia in COPD patients," he said. "All medication decisions involve a risk/benefit analysis. Doctors should keep the risk in mind and weigh it against actual benefits, always in full consultation with the patient, who should make the ultimate decision."
There's more on COPD at the U.S. National Heart, Lung, and Blood Institute.
Posted: November 2008
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