title: Inhaled corticosteroids increase the risk of oropharyngeal colonization by Streptococcus pneumoniae in children with asthma.
abstract: OBJECTIVE
  Recent studies have raised concerns about the link between use of inhaled corticosteroids (ICS) and risk of pneumonia in patients with chronic obstructive pulmonary disease. This cross-sectional study aimed to investigate the association between ICS and oropharyngeal colonization by Streptococcus pneumoniae (S. pneumoniae) among children (up to 18 years old) with asthma.
  
  
  METHODS
  Two age-matched groups of patients were consecutively recruited: (i) exposed group: children who had persistent asthma and were being treated with daily ICS for at least 30 days and (ii) non-exposed group: children who had asthma and were not being treated with ICS at study entry. Oropharyngeal specimens from the tonsillar area and posterior pharyngeal wall were collected. S. pneumoniae was identified according to National Committee for Clinical Laboratory Standards recommendations.
  
  
  RESULTS
  A total of 200 consecutive patients were recruited and 192 (96 in each group) were included in the analysis. In the exposed group, the mean daily dose of ICS was 400 µg of beclomethasone or equivalent and the mean duration of treatment was 8.6 months. The prevalence of oropharyngeal colonization by S. pneumoniae was higher in the exposed group compared with the non-exposed group (27.1% vs 8.3%, P = 0.001). After adjusting for potential confounders, use of ICS was an independent risk factor for oropharyngeal carriage of S. pneumoniae, with an adjusted prevalence ratio of 3.75 (95% confidence interval: 1.72-8.18, P = 0.001).
  
  
  CONCLUSIONS
  Regular use of ICS is associated with an increased risk of having oropharyngeal colonization by S. pneumoniae in children with asthma.
authors.affiliation: Maternal and Child Health, Faculty of Medicine, Federal University of Rio Grande University of Anhanguera, Rio Grande, Brazil. zhanglinjie63@yahoo.com.br
authors.forename: Linjie
authors.initials: L
authors.lastname: Zhang
authors.forename: Sílvio O M
authors.initials: SO
authors.lastname: Prietsch
authors.forename: Ana Paula
authors.initials: AP
authors.lastname: Mendes
authors.forename: Andrea
authors.initials: A
authors.lastname: Von Groll
authors.forename: Gicelle Porto
authors.initials: GP
authors.lastname: Rocha
authors.forename: Lillian
authors.initials: L
authors.lastname: Carrion
authors.forename: Pedro Eduardo Almeida
authors.initials: PE
authors.lastname: Da Silva
mesh_terms: D000280:Administration, Inhalation; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage* / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy*; D001507:Beclomethasone / Q000008:administration & dosage / Q000627:therapeutic use; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D008297:Male; D009960:Oropharynx / Q000382:microbiology*; D011008:Pneumococcal Infections / Q000453:epidemiology*; D015995:Prevalence; D012307:Risk Factors; D013296:Streptococcus pneumoniae / Q000302:isolation & purification*
chemical_list: D000305:Adrenal Cortex Hormones; D001507:Beclomethasone