Data in a recent study showed that users of inhaled corticosteroids (ICS) had a higher rate of pneumonia and tuberculosis, with concomitant pneumonia independently linked with higher mortality, emphasizing the importance of cautious and targeted administration of ICS in chronic obstructive pulmonary disease (COPD), according to a study published in the International Journal of Chronic Obstructive Pulmonary Disease.
This study was conducted with the aim of providing comprehensive analysis of ICS on COPD in a real-world setting that could help answer questions around safety concerns with ICS in COPD.
Researchers were trying to explore the impact of ICS on the prognosis of Asian patients with COPD in the real-life world.
“Although [COPD] has been a major public health concern and was expected to rank third among all the causes of death by 2030, there is still no therapeutic intervention that modifies the natural course of COPD,” the researchers wrote. The use of ICS in COPD is debated due to the associated safety concerns, even though it is a component of traditional medication therapy for COPD.
They examined 978 patients with COPD registered in the Korean National Health and Nutrition Examination Survey database and whose data were linked to Health Insurance and Review Assessment (HIRA) data. The outcome measures were determined by HIRA from January 1, 2009, to December 30, 2012. The study enrolled 2 arms: ICS users (n = 85; mean age, 66.7 [8.9] years) and non-ICS users (n = 893; mean [SD] age, 63.7 [9.7] years).
The ICS users had higher rates of pneumonia, tuberculosis, and acute exacerbations (all P < .05) compared with patients who didn’t use ICS. Respiratory-caused hospitalizations were also higher among ICS users (P < .05). An additional multivariate analysis showed that old age, forced expiratory volume (FEV), ICS therapy, and pneumonia were independently associated with higher mortality (P < .05).
The data showed that ICS therapy was associated with the outcome of pneumonia in univariate analysis along with a tendency to have a connection with pneumonia in multivariate analysis. Additionally, ICS users with COPD in this study had a greater rate of tuberculosis and experienced more frequent hospitalization because of respiratory diseases.
It was also noted that ICS users had a higher rate of pneumonia in all COPD subgroups and had a higher admission rate due to respiratory causes in mild and moderate COPD subgroups. These data were supported by a recent study on the incidence of adverse events including pneumonia and an additional study in a real-world setting of the incidence of severe pneumonia required hospitalization, both with the use of ICS.
Researchers stated that considering the overprescription of ICD in observational studies is extensive, clinicians should consider their potential harm even when appropriately prescribed for COPD.
“Potential negative health consequences related to inappropriate prescribing of ICS include a high incidence of respiratory infection, hoarseness, skin bruising, decreased bone density, fracture, increased risk of diabetes, and cataract,” the researchers wrote. Additionally, ICS therapy can also increase the risk of respiratory infections and other adverse events.
The researchers noted that their findings should be interpreted with caution because of the observational study design. Frequent exacerbations associated with ICS therapy might just reflect a clinical practice of prescribing ICS therapy for COPD in South Korea, and further validation is needed.
The number of subjects enrolled in the study was not large enough to conclude the harmful adverse effects of ICS in subgroups of COPD. The study is also not a randomized controlled trial and there was lower baseline pulmonary function in the ICS group, which could also be a limitation. Hence, the subgroup analysis based on COPD severity was conducted considering the lower baseline FEV in ICS users.
Park JW, Hong Y, Rhee CK, et al. The impact of inhaled corticosteroids on the prognosis of chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis. 2023;18:733-743. doi:10.2147/COPD.S388367