SOURCE: Suissa S, et al. Discontinuation of inhaled corticosteroids in COPD and the risk reduction of pneumonia. Chest 2015;148:1177-1183.
For patients with moderate to severe chronic obstructive pulmonary disease (COPD), combination treatment often includes anticholinergics, long-acting beta-agonists, and inhaled corticosteroids (ICS), the latter two treatments most commonly combined into a single inhalation device. As many as 85% of COPD patients are prescribed ICS, though many may fall below the threshold for ICS treatment recommended by FDA labeling or guidelines. Observational data have reported an increased incidence of pneumonia in COPD patients who used ICS, which prompts the question of whether discontinuation of ICS reduces the likelihood of pneumonia. Suissa et al used the Quebec health insurance database to evaluate a population of COPD patients who had been prescribed ICS (n = 103,386). Among this population, a comparison was made of the incidence of pneumonia in patients who continued to be treated with ICS vs those COPD patients who had discontinued ICS. The period of observation was approximately 5 years.
They found that the likelihood of serious pneumonia was reduced by 37% in patients who discontinued ICS vs those who remained on ICS. Risk reduction was demonstrated as quickly as the first month post-ICS cessation. Among ICS treatments, risk reduction was more dramatic with fluticasone cessation (42%) than budesonide (13%), but omitting either ICS was beneficial for pneumonia risk reduction. The authors suggested that ICS may be currently over-prescribed, and that limiting their use could reduce the risk for pneumonia without compromising quality of care.