A study published online in CHEST on June 25, 2015 finds that discontinuing inhaled corticosteroids for COPD patients reduced the risk of pneumonia by 37%, with the greatest reduction in risk associated with stopping inhaled fluticasone. The reduction in risk was not as great after discontinuation of budesonide.
The study authors identified over 103,000 COPD patients treated with ICS in the Quebec health insurance databases. All of the patients were over 55 years old, and those with diagnoses of asthma were excluded.
Of those patients, 14,020 were hospitalized for pneumonia during an approximately 5-year follow-up period. According to the authors, the data showed that one month after discontinuing ICS, the reduction in risk of pneumonia was 20%. After four months, the risk dropped by 50%, then leveled off.
Noting that several previous randomized studies have shown no significant reduction in pneumonia risk after discontinuation of ICS, the authors suggest that the those studies may have followed too few patients for too short a time given that the expected rate of serious pneumonia among COPD patients is 2-3% per year.
Given the significant reduction in risk found in this study, they say, “we conclude that limiting the use of ICS to the patients with COPD who are likely to benefit, such as patients with an asthma component, and weaning the others off ICS will result in a major reduction in the risk of serious pneumonia.”
Read the CHEST abstract.
