Inhaled corticosteroids (ICS) may increase the risk of pneumonia, according to a Canadian study of 152,412 asthma patients aged between 12 and 35 years.

Current ICS use was associated with an 83 per cent increased risk of being hospitalised for pneumonia, equivalent to an excess risk of 1.44 cases per 1,000 person-years after adjusting for confounders. Increased risks emerged with budesonide (167 per cent increase) and fluticasone (93 per cent increase) compared to non-users. The 23 per cent increased risk with other ICS was not statistically significant.

Pneumonia risk was greatest with higher doses: at least 500mcg fluticasone-equivalent a day was associated with a 96 per cent increase compared to a 60 per cent increase with less than 250mcg fluticasone-equivalent a day.

“While the increase in risk of pneumonia with the use of inhaled corticosteroids is well recognised in COPD, in asthma patients the evidence has been equivocal,” says senior author Pierre Ernst, from the center for clinical epidemiology, Jewish General Hospital, Montreal.

“Our study suggests the risk may be present in asthma, although pneumonia in patients with asthma remains unusual and inhaled corticosteroids remain the best therapy available,” he points out.

^{(Br J Clinical Pharmacol DOI: 10.1111/bcp.13295)}