Pneumonia in elderly patients with chronic obstructive pulmonary disease.

This article reviews the association between pneumonia and chronic obstructive pulmonary disease (COPD) and the possible role of inhaled corticosteroids in increasing the risk of pneumonia in patients with COPD. An increased risk of pneumonia with inhaled corticosteroids was first reported from the Toward Revolution in COPD Health (TORCH) study, a large randomized clinical trial comparing fluticasone, salmeterol, or a combination of the two medications with placebo. We carried out a large observational study using a health care administrative database of information on hospitalizations and medication use among patients older than 65 years of age in Quebec. We found an excess of pneumonia requiring hospitalization and an excess of pneumonia hospitalizations leading to death in relation to current use of inhaled corticosteroids, especially at high doses. Here, we explore the potential mechanisms of this association and try to weigh the benefits and risks of therapy with inhaled corticosteroids in patients with COPD.