title: Managing the safety of inhaled corticosteroids in COPD and the risk of pneumonia.
abstract: BACKGROUND
  Inhaled corticosteroids (ICS) are known to increase the risk of pneumonia in patients with chronic obstructive pulmonary disease. To estimate the association between ICS and pneumonia among users of ICS relative to non-ICS users and to examine whether this risk is dose related, class related and what's its association with the pneumonia-mortality or overall mortality.
  
  
  METHODS
  Through a comprehensive literature search of MEDLINE, EMBASE, Cochrane Library, and ClinicalTrials.gov from inception to February 2015, we identified randomized controlled trials of ICS therapy lasting at least 6 months. We conducted meta-analyses to generate summary estimates comparing ICS with non-ICS treatment on the risk of pneumonia.
  
  
  CONCLUSIONS
  ICS alone or in combination with long-acting β-agonists are associated with an increased risk of pneumonia but have no effect on pneumonia related mortality. It is important to identify those patients to benefit the most from ICS, as those with frequent exacerbations, a severe airway obstruction, a positive bronchodilator test or a sputum eosinophilia despite treatment.
authors.affiliation: Sotiria Hospital, 6th Respiratory Department , Mesogion 152, 11527, Athens , Greece +30 21 0776 3458 ; mliapikou@yahoo.com.
authors.forename: Adamantia
authors.initials: A
authors.lastname: Liapikou
authors.forename: Michael
authors.initials: M
authors.lastname: Toumbis
authors.forename: Antoni
authors.initials: A
authors.lastname: Torres
mesh_terms: D000280:Administration, Inhalation; D000318:Adrenergic beta-Agonists / Q000008:administration & dosage / Q000009:adverse effects; D000818:Animals; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D005938:Glucocorticoids / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D011014:Pneumonia / Q000139:chemically induced* / Q000453:epidemiology / Q000401:mortality; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy*; D012306:Risk
chemical_list: D000318:Adrenergic beta-Agonists; D005938:Glucocorticoids
keywords: chronic obstructive pulmonary disease; inhaled corticosteroids; long-acting β-agonists; mortality; pneumonia