Inhaler use seen raising illness risk

JHU study finds pneumonia 34% more likely with steroid treatment

November 26, 2008|By Kelly Brewington | Kelly Brewington,kelly.brewington@baltsun.com

Researchers at the Johns Hopkins University are urging doctors to use caution when prescribing steroid inhalers to treat a common - and sometimes fatal - lung disease after a study found they increased the risk of pneumonia in some patients by 34 percent.

About half of all patients with chronic obstructive pulmonary disease, or COPD, use steroid inhalers to ease the wheezing and breathlessness caused by the condition.

Although medical experts have known for years that inhalers are effective in treating symptoms, doctors have raised questions about side effects and whether they help people live longer, said Dr. M. Bradley Drummond, a pulmonologist at the Hopkins School of Medicine and the study's lead author.

"Because these agents are so effective at controlling symptoms, we do feel there is a good role for inhaled steroids for treating COPD," he said. "But for some patients, there may be more harm than benefits."

The study, which appears in this week's Journal of the American Medical Association, also found that while the inhalers helped, they did not extend a patient's life after one year of use.

An estimated 10 million to 15 million Americans have COPD, which encompasses emphysema and chronic bronchitis. The disease, which is most often caused by smoking, is the nation's fourth-leading cause of death. It is characterized by shortness of breath, extra phlegm, wheezing and an inability to tolerate light exercise or even walking up a flight of stairs. Inhaled steroids, sold under brand names such as Advair and Pulmicort, help by decreasing the amount of inflammation, or swelling, in the lungs.

In Baltimore, where 28 percent of people reportedly smoke - the national average is 21 percent - an estimated 25,000 people have COPD, Drummond said.

The study examined 11 clinical trials, including 14,426 patients. Investigators compared the incidence of pneumonia in those who used inhalers with the incidence of those who did not.

Experts are not sure why inhalers appeared to increase the risk of pneumonia, but they believe they may weaken a person's immune system. Drummond said the risk of pneumonia appeared to increase in people with worse lung function and those who took the highest dose of steroids. But such patients represented too small a group for researchers to say for certain, he said.

Patients who use the inhalers should not stop, Drummond advised. Rather, they should talk with their doctors if they have concern.

There is no cure for COPD, and treatments are limited. Some people can benefit from other types of inhalers, which relax the muscles around the airways, and oxygen therapy. For patients who smoke, the most important step they can take is to stop, Drummond said.

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