title: Inhaled Corticosteroids and Respiratory Infections in Children With Asthma: A Meta-analysis.
abstract: BACKGROUND
  Inhaled corticosteroids (ICS) are associated with an increased risk of pneumonia in adult patients with chronic obstructive pulmonary disease.
  
  
  OBJECTIVE
  To assess the association between ICS use and risk of pneumonia and other respiratory infections in children with asthma.
  
  
  METHODS
  We searched PubMed from inception until May 2015. We also searched clinicaltrials.gov and databases of pharmaceutical manufacturers.
  
  
  METHODS
  We selected randomized trials that compared ICS with placebo for at least 4 weeks in children with asthma.
  
  
  METHODS
  We included 39 trials, of which 31 trials with 11 615 patients contributed data to meta-analyses.
  
  
  RESULTS
  The incidence of pneumonia was 0.58% (44/7465) in the ICS group and 1.51% (63/4150) in the placebo group. The meta-analysis of 9 trials that revealed at least 1 event of pneumonia revealed a reduced risk of pneumonia in patients taking ICS (risk ratio [RR]: 0.65; 95% confidence interval [CI]: 0.44 to 0.94). Using risk difference as effect measure, the meta-analysis including all 31 trials revealed no significant difference in the risk of pneumonia between the ICS and placebo groups (risk difference: -0.1%; 95% CI: -0.3% to 0.2%). No significant association was found between ICS and risk of pharyngitis (RR: 1.01; 95% CI: 0.87 to 1.18), otitis media (RR: 1.07; 95% CI: 0.83 to 1.37), and sinusitis (RR: 0.89; 95% CI: 0.76 to 1.05).
  
  
  CONCLUSIONS
  Lack of clearly defined criteria for respiratory infections and possible publication bias.
  
  
  CONCLUSIONS
  Regular use of ICS may not increase the risk of pneumonia or other respiratory infections in children with asthma.
authors.affiliation: Postgraduate Program in Public Health.
authors.forename: Cristine
authors.initials: C
authors.lastname: Cazeiro
authors.affiliation: Faculty of Medicine, Federal University of Rio Grande, Rio Grande, Brazil; and.
authors.forename: Cristina
authors.initials: C
authors.lastname: Silva
authors.affiliation: Faculty of Medicine, Federal University of Rio Grande, Rio Grande, Brazil; and.
authors.forename: Susana
authors.initials: S
authors.lastname: Mayer
authors.affiliation: Faculty of Medicine, Federal University of Rio Grande, Rio Grande, Brazil; and.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Mariany
authors.affiliation: Department of Respiratory and Sleep Medicine, Lady Cilento Children's Hospital and School of Medicine, The University of Queensland, Brisbane, Australia.
authors.forename: Claire Elizabeth
authors.initials: CE
authors.lastname: Wainwright
authors.affiliation: Postgraduate Program in Public Health, lzhang@furg.br.|Faculty of Medicine, Federal University of Rio Grande, Rio Grande, Brazil; and.|Postgraduate Program in Health Science, and.
authors.forename: Linjie
authors.initials: L
authors.lastname: Zhang
mesh_terms: D001249:Asthma / Q000188:drug therapy*; D002648:Child; D004305:Dose-Response Relationship, Drug; D005938:Glucocorticoids / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D009330:Nebulizers and Vaporizers; D010033:Otitis Media / Q000209:etiology; D016032:Randomized Controlled Trials as Topic; D012141:Respiratory Tract Infections / Q000209:etiology*
chemical_list: D005938:Glucocorticoids