title: Inhaled corticosteroids and systemic inflammatory response in community-acquired pneumonia: a prospective clinical study.
abstract: OBJECTIVE
  The previous use of inhaled corticosteroids (ICS) may reduce the inflammatory response and mortality in patients with community-acquired pneumonia (CAP).
  
  
  METHODS
  We measured serum levels of several inflammatory biomarkers, as well as mortality at various time-points, in 663 consecutive patients hospitalized for CAP; 128 (19%) were receiving chronic outpatient treatment with ICS. Patients on previous oral corticosteroids were excluded from the analysis.
  
  
  RESULTS
  On admission, patients treated with ICS were older; had been diagnosed with chronic obstructive pulmonary disease (COPD), asthma and pneumonia in the previous year more often; and had higher CAP severity risk classes and lower tumour necrosis factor (TNF)-alpha (P < 0.001) and interleukin (IL)-6 (P = 0.015) serum levels. After adjusting for potential confounders, this association persisted for TNF-alpha (P < 0.001), but not for IL-6. Mortality at 30 and 90 days tended to be lower in patients treated with ICS (P = 0.062 and 0.050, respectively), but mortality was similar after 1 year in both groups (16, 13% vs 81, 15% for patients treated and not treated with ICS, respectively). Hospital readmission rate after 1 year was higher in patients treated with ICS (49, 38% vs 109, 20%, P < 0.001). The association of ICS treatment with a previous diagnosis of pneumonia, lower levels of TNF-alpha and IL-6 on admission and higher readmission rates during follow up persisted in the subpopulation of 210 patients with COPD.
  
  
  CONCLUSIONS
  Previous use of ICS in patients hospitalized for CAP is associated with a reduced systemic inflammatory response without any impact on long-term mortality.
authors.affiliation: Department of Pneumology, Thorax Institute, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain.
authors.forename: Miquel
authors.initials: M
authors.lastname: Ferrer
authors.forename: Antoni
authors.initials: A
authors.lastname: Torres
authors.forename: Raquel
authors.initials: R
authors.lastname: Martínez
authors.forename: Paula
authors.initials: P
authors.lastname: Ramírez
authors.forename: Eva
authors.initials: E
authors.lastname: Polverino
authors.forename: Beatriz
authors.initials: B
authors.lastname: Montull
authors.forename: Salvador
authors.initials: S
authors.lastname: Sialer
authors.forename: Michael S
authors.initials: MS
authors.lastname: Niederman
authors.forename: Alvar
authors.initials: A
authors.lastname: Agusti
authors.forename: Rosario
authors.initials: R
authors.lastname: Menéndez
mesh_terms: D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage* / Q000627:therapeutic use*; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D001991:Bronchitis / Q000097:blood / Q000209:etiology / Q000517:prevention & control*; D017714:Community-Acquired Infections / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D015897:Comorbidity; D005260:Female; D006801:Humans; D015850:Interleukin-6 / Q000097:blood; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications; D012189:Retrospective Studies; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000097:blood
chemical_list: D000305:Adrenal Cortex Hormones; D015415:Biomarkers; D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha
keywords: community-acquired pneumonia; inflammatory biomarker; inhaled corticosteroid; systemic inflammatory response; tumour necrosis factor-alpha