title: Inhaled corticosteroids and the risk of pneumonia in people with asthma: a case-control study.
abstract: BACKGROUND
  In clinical trials, the use of inhaled corticosteroids is associated with an increased risk of pneumonia in people with COPD, but whether the same is true for people with asthma is not known.
  
  
  METHODS
  With the use of primary care data from The Health Improvement Network, we identified people with asthma, and from this cohort, we identified patients with pneumonia or lower respiratory tract infection and age- and sex-matched control subjects. Conditional logistic regression was used to determine the association between the dose and type of inhaled corticosteroid and the risk of pneumonia or lower respiratory tract infection.
  
  
  RESULTS
  A dose-response relationship was found between the strength of inhaled corticosteroid dose and risk of pneumonia or lower respiratory tract infection (P &lt; .001 for trend) such that after adjusting for confounders, people receiving the highest strength of inhaled corticosteroid (≥ 1,000 μg) had a 2.04 (95% CI, 1.59-2.64) increased risk of pneumonia or lower respiratory tract infection compared with those with asthma who did not have a prescription for inhaled corticosteroids within the previous 90 days.
  
  
  CONCLUSIONS
  People with asthma receiving inhaled corticosteroids are at an increased risk of pneumonia or lower respiratory infection, with those receiving higher doses being at greater risk. Pneumonia should be considered as a possible side effect of inhaled corticosteroids, and the lowest possible dose of inhaled corticosteroids should be used in the management of asthma.
authors.affiliation: Division of Epidemiology and Public Health, University of Nottingham, Nottingham, England.
authors.forename: Tricia
authors.initials: T
authors.lastname: McKeever
authors.affiliation: Respiratory Research Unit, University of Nottingham, Nottingham, England.
authors.forename: Timothy W
authors.initials: TW
authors.lastname: Harrison
authors.affiliation: Division of Epidemiology and Public Health, University of Nottingham, Nottingham, England.
authors.forename: Richard
authors.initials: R
authors.lastname: Hubbard
authors.affiliation: Respiratory Research Unit, University of Nottingham, Nottingham, England. Electronic address: dominic.shaw@nottingham.ac.uk.
authors.forename: Dominick
authors.initials: D
authors.lastname: Shaw
mesh_terms: D000280:Administration, Inhalation; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage* / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001249:Asthma / Q000188:drug therapy*; D016022:Case-Control Studies; D019468:Disease Management; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000453:epidemiology*; D012141:Respiratory Tract Infections / Q000453:epidemiology; D012307:Risk Factors; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones