title: Risks of pneumonia in patients with asthma taking inhaled corticosteroids.
abstract: BACKGROUND
  Inhaled corticosteroids (ICS) are the mainstay of asthma treatment. Studies in chronic obstructive pulmonary disease reported increased rates of pneumonia with ICS. Concerns exist about an increased pneumonia risk in patients with asthma taking ICS.
  
  
  OBJECTIVE
  To evaluate the risks of pneumonia in patients with asthma taking ICS.
  
  
  METHODS
  A retrospective analysis evaluated studies of the ICS budesonide in asthma. The primary data set were all double-blind, placebo-controlled trials lasting at least 3 months, involving budesonide (26 trials, n = 9,067 for budesonide; n = 5,926 for the comparator) sponsored by AstraZeneca. A secondary data set evaluated all double-blind trials lasting at least 3 months but without placebo control (60 trials, n = 33,496 for budesonide, n = 2,773 for fluticasone propionate). Cox proportional hazards regression modeling was used to estimate the relative effect of ICS on pneumonia adverse events (AEs) or serious adverse events (SAEs).
  
  
  RESULTS
  In the primary data set, the occurrence of pneumonia AEs was 0.5% (rate 10.0 events/1,000 patient-years [TPY]) for budesonide and 1.2% (19.3 per TPY) for placebo (hazard ratio, 0.52; 95% confidence interval, 0.36-0.76; P < 0.001); the occurrence of pneumonia SAEs was 0.15% (2.9 per TPY) for budesonide and 0.13% (2.1 per TPY) for placebo (hazard ratio, 1.29; 95% confidence interval, 0.53-3.12; P = 0.58). In the secondary data set, the percentage of patients reporting pneumonia AEs was 0.70% (12.7 per TPY), whereas the percentage of patients reporting pneumonia SAEs was 0.17% (3.1 per TPY). There was no increased risk with higher budesonide doses or any difference between budesonide and fluticasone.
  
  
  CONCLUSIONS
  There is no increased risk of pneumonia in patients with asthma, identified as an AE or SAE, in clinical trials using budesonide.
authors.affiliation: Firestone Institute for Respiratory Health, Michael G. DeGroote School of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada. obyrnep@mcmaster.ca
authors.forename: Paul M
authors.initials: PM
authors.lastname: O'Byrne
authors.forename: Soren
authors.initials: S
authors.lastname: Pedersen
authors.forename: Lars-Göran
authors.initials: LG
authors.lastname: Carlsson
authors.forename: Finn
authors.initials: F
authors.lastname: Radner
authors.forename: Anders
authors.initials: A
authors.lastname: Thorén
authors.forename: Stefan
authors.initials: S
authors.lastname: Peterson
authors.forename: Pierre
authors.initials: P
authors.lastname: Ernst
authors.forename: Samy
authors.initials: S
authors.lastname: Suissa
mesh_terms: D000280:Administration, Inhalation; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage* / Q000009:adverse effects*; D000328:Adult; D000368:Aged; D000730:Androstadienes / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D001249:Asthma / Q000188:drug therapy* / Q000453:epidemiology*; D001993:Bronchodilator Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D019819:Budesonide / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D015984:Causality; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D004311:Double-Blind Method; D005260:Female; D000068298:Fluticasone; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000139:chemically induced* / Q000453:epidemiology*; D016016:Proportional Hazards Models; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones; D000730:Androstadienes; D001993:Bronchodilator Agents; D019819:Budesonide; D000068298:Fluticasone