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Inhaled corticosteroids in hospital boosts survival for pneumonia, COPD

Kathleen Blanchard's picture

A large study finds patient with lung disease and hospitalized for pneumonia have higher survival rates when treated with inhaled corticosteroids.The findings, from the American Thoracic Society, suggests a change in clinical practice guidelines. Despite concerns that steroids increase rates of pneumonia for COPD patients, the study found inhaled steroids boost survival.

Large study shows benefits of inhaled corticosteroids for COPD and pneumonia

The large study showed patients with COPD (chronic obstructive pulmonary disease) who were hospitalized for pneumonia and not treated with inhaled corticosteroids were 25 percent more likely to die compared to those who received the treatments.

In the large study that included almost 16,000 COPD patients admitted to VA hospitals, researchers found "..."the opposite of what many experts have believed", that inhaled corticosteroids should not be used for patients with the lung disease and pneumonia.

According to Eric Mortensen, MD, investigator at VERDICT (Veterans Evidence-based Research, Dissemination, and Implementation Center, who led the study, "This was the first large rigorous study to examine whether this was in fact the case." Mortensen said many experts believe ICS treatments should be withheld from COPD patients, based on a series of past studies that showed steroid medications inhaled into the lungs boost pneumonia rates.

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Mortensen advises, "These results should reassure clinicians that they can give their COPD patients ICS without fearing that the increased risk of pneumonia will translate into higher risk of mortality."

The comparison results were significant. The researchers looked at all-cause mortality between the two groups at 30- and 90-days - 13.6 percent of patients not given inhaled corticosteroids died within 30 days compared with 10.2 percent of patients treated with ICS. At 90 days, mortality rates for ICS and non inhaled steroid users was 17.3 an 22.8 percent respectively.

Overall mortality among patients with COPD and pneumonia who were not treated with inhaled corticosteroids was 25 percent.

Dr. Mortensen says the study show patients with COPD, hospitalized with pneumonia, benefit from inhaled corticosteroids. Based on the findings, it may be be helpful to consider ICS for a subset of hospitalized patients with pneumonia that Mortensen says is the next "really big question." The VA study shows increased survival for patients with COPD and pneumonia from inhaled corticosteroids, despite concerns from a series of studies that ICS raises the risk of pneumonia.

American Journal of Respiratory and Critical Care Medicine
"Observational Study of the Impact of Inhaled Corticosteroid Therapy on Outcomes
for Patients with COPD and Hospitalized with Pneumonia"
Dennis Chen, BS, Marcos I. Restrepo, MD, MSc, Michael J. Fine, MD, MSc, Mary Jo V. Pugh, PhD
Antonio Anzueto, MD, Mark L. Metersky, MD, Brandy Nakashima, MA, Chester Good, MD and
Eric M. Mortensen, MD, MSc

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