Vikas Bansal1, Muhammad A Mangi1, Margaret M Johnson1, Emir Festic2. 1. Pulmonary and Critical Care Medicine, Mayo Clinic, Jacksonville, FL. 2. Pulmonary and Critical Care Medicine, Mayo Clinic, Jacksonville, FL. festic.emir@mayo.edu.
Abstract
OBJECTIVES: To systematically review all available studies on inhaled corticosteroid use and incident pneumonia in asthma patients. METHODS: We performed a literature search from January 1, 1993, through August 15, 2015, using PubMed, Medline, CENTRAL, EMBASE, Scopus, ISI, Regulatory Documents, Web of Science and manufacturers' web clinical trial registries with multiple search terms. We included studies that compared the risk of incident pneumonia among patients utilizing and not utilizing inhaled corticosteroids. We then summarized risk estimates into two random-effect meta-analyses; one including randomized controlled trials and another one including observational studies. RESULTS: Fourteen studies were estimable; ten randomized controlled trials included 19,098 participants and four observational studies included 44,016 participants. There was no heterogeneity in randomized trials and summed risk ratio demonstrated the use of inhaled corticosteroids was protective of pneumonia; risk ratio 0.74, 95% CI 0.57 to 0.95, p=0.02. On the contrary, observational studies showed summed odds ratio of 1.97; 95% CI 1.87 to 2.07, p<0.0001, I²=0%, suggesting increased risk of pneumonia with use of inhaled corticosteroids in asthma patients. CONCLUSIONS: Inhaled corticosteroids are associated with decreased risk of incident pneumonia in patients with asthma based on meta-analysis of available randomized trials. Although observational studies in similar patients suggested higher risk of pneumonia, the inherent methodological limitations confer lower grade of confidence in these studies.
OBJECTIVES: To systematically review all available studies on inhaled corticosteroid use and incident pneumonia in asthmapatients. METHODS: We performed a literature search from January 1, 1993, through August 15, 2015, using PubMed, Medline, CENTRAL, EMBASE, Scopus, ISI, Regulatory Documents, Web of Science and manufacturers' web clinical trial registries with multiple search terms. We included studies that compared the risk of incident pneumonia among patients utilizing and not utilizing inhaled corticosteroids. We then summarized risk estimates into two random-effect meta-analyses; one including randomized controlled trials and another one including observational studies. RESULTS: Fourteen studies were estimable; ten randomized controlled trials included 19,098 participants and four observational studies included 44,016 participants. There was no heterogeneity in randomized trials and summed risk ratio demonstrated the use of inhaled corticosteroids was protective of pneumonia; risk ratio 0.74, 95% CI 0.57 to 0.95, p=0.02. On the contrary, observational studies showed summed odds ratio of 1.97; 95% CI 1.87 to 2.07, p<0.0001, I²=0%, suggesting increased risk of pneumonia with use of inhaled corticosteroids in asthmapatients. CONCLUSIONS: Inhaled corticosteroids are associated with decreased risk of incident pneumonia in patients with asthma based on meta-analysis of available randomized trials. Although observational studies in similar patients suggested higher risk of pneumonia, the inherent methodological limitations confer lower grade of confidence in these studies.
Authors: Samatha Sonnappa; Richard Martin; Elliot Israel; Dirkje Postma; Wim van Aalderen; Annie Burden; Omar S Usmani; David B Price Journal: PLoS One Date: 2017-06-15 Impact factor: 3.240
Authors: Matthew J Martin; Nur Masirah M Zain; Glenn Hearson; Damian W Rivett; Garrit Koller; David J Wooldridge; Graham Rose; Saheer E Gharbia; Ben Forbes; Kenneth D Bruce; Tim W Harrison Journal: PLoS One Date: 2020-12-30 Impact factor: 3.240