Use of Inhaled Corticosteroids in Patients With COPD and the Risk of TB and Influenza

Dong, Yaa Hui; Chang, Chia‐Hsuin; Wu, Fe-Lin Lin; Shen, Li‐Jiuan; Calverley, Peter M.A.; Löfdahl, Claes Gor̈an; Lai, Mei‐Shu; Mahler, Donald A.

doi:10.1378/chest.13-2137

Cited by 82 publications

(58 citation statements)

References 55 publications

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“…The risk of TB was even higher for patients living in endemic areas [Dong et al 2014]. Another 2014 meta-analysis reported that ICS use increases the risk of TB among patients with COPD and patients with history of past pulmonary TB [Songshi et al 2014].…”

Section: Other Ics-related Infectionsmentioning

confidence: 99%

Inhaled corticosteroids and the increased risk of pneumonia: what’s new? A 2015 updated review

Iannella

Luna

Waterer

2016

Ther Adv Respir Dis

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There is a considerable amount of evidence that supports the possibility of an increased risk of pneumonia associated with prolonged use of inhaled corticosteroids (ICS) in patients with chronic obstructive pulmonary disease (COPD). However, as yet, no statistically significant increase in pneumonia-related 30-day mortality in patients on ICS has been demonstrated. The lack of objective pneumonia definitions and radiological confirmations have been a major source of bias, because of the similarities in clinical presentation between pneumonia and acute exacerbations of COPD. One of the newer fluticasone furoate studies overcomes these limitations and also provides an assessment of a range of doses, suggesting that the therapeutic window is quite narrow and that conventional dosing has probably been too high, although the absolute risk may be different compared to other drugs. Newer studies were not able to rule out budesonide as responsible for pneumonia, as previous evidence suggested, and there is still need for evidence from head-to-head comparisons in order to better assess possible intra-class differences. Although the exact mechanisms by which ICS increase the risk of pneumonia are not fully understood, the immunosuppressive effects of ICS on the respiratory epithelium and the disruption of the lung microbiome are most likely to be implicated. Given that COPD represents such a complex and heterogeneous disease, attempts are being made to identify clinical phenotypes with clear therapeutic implications, in order to optimize the pharmacological treatment of COPD and avoid the indiscriminate use of ICS. If deemed necessary, gradual withdrawal of ICS appears to be well tolerated. Vaccination against pneumococcus and influenza should be emphasized in patients with COPD receiving ICS. Physicians should keep in mind that signs and symptoms of pneumonia in COPD patients may be initially indistinguishable from those of an exacerbation, and that patients with COPD appear to be at increased risk of developing pneumonia as a complication of ICS therapy.

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Section: Other Ics-related Infectionsmentioning

confidence: 99%

Inhaled corticosteroids and the increased risk of pneumonia: what’s new? A 2015 updated review

Iannella

Luna

Waterer

2016

Ther Adv Respir Dis

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“…42,120,[124][125][126] Results of observational studies suggest that ICS treatment could also be associated with increased risk of diabetes/poor control of diabetes, 127 cataracts, 128 and mycobacterial infection 129 including tuberculosis. 130,131 In the absence of RCT data on these issues, it is not possible to draw firm conclusions. 132 An increased risk of tuberculosis has been found in both observational studies and a metaanalysis of RCTs.…”

Section: Adverse Effectsmentioning

confidence: 99%

Exploration de la fonction pulmonaire par spirométrie

Bridevaux¹,

Petitpierre²,

Bloch³

et al. 2018

Swiss Med Forum

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“…Un principio básico en la medicina es tratar a los pacientes con la mínima cantidad de medicamentos necesarios para alcanzar los objetivos clínicos. Estos datos cobran especial relevancia al tener presente la evidencia acumulada acerca de los efectos adversos asociados con el empleo de esteroides inhalados en el paciente con EPOC, tales como aumento del riesgo de neumonía (13), si bien no de la mortalidad asociada (14), incremento en el riesgo de tuberculosis (15), micobacterias no tuberculosas (16), influenza (17), diabetes (18), cataratas (19), osteoporosis y candidiasis orofaríngea (20).…”

Section: Comentariounclassified

Descontinuación del esteroide inhalado en pacientes con enfermedad pulmonar obstructiva crónica moderada a severa no aumenta el riesgo de exacerbaciones

Preciado

2016

rev. colomb. neumol.

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Use of Inhaled Corticosteroids in Patients With COPD and the Risk of TB and Influenza

Cited by 82 publications

References 55 publications

Inhaled corticosteroids and the increased risk of pneumonia: what’s new? A 2015 updated review

Inhaled corticosteroids and the increased risk of pneumonia: what’s new? A 2015 updated review

Exploration de la fonction pulmonaire par spirométrie

Descontinuación del esteroide inhalado en pacientes con enfermedad pulmonar obstructiva crónica moderada a severa no aumenta el riesgo de exacerbaciones

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