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Original Research: Asthma |

Inhaled Corticosteroids and the Risk of Pneumonia in People With AsthmaInhaled Corticosteroids and the Risk of Pneumonia: A Case-Control Study

Tricia McKeever, PhD; Timothy W. Harrison, MD; Richard Hubbard, MD; Dominick Shaw, MD
Author and Funding Information

From the Division of Epidemiology and Public Health (Drs McKeever and Hubbard) and Respiratory Research Unit (Drs Harrison and Shaw), University of Nottingham, Nottingham, England.

Correspondence to: Dominick Shaw, MD, Respiratory Research Unit, University of Nottingham, Edwards Ln, Nottingham, NG5 1PB, England; e-mail: dominic.shaw@nottingham.ac.uk


Funding/Support: The authors have reported to CHEST that no funding was received for this study.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;144(6):1788-1794. doi:10.1378/chest.13-0871
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Published online

Background:  In clinical trials, the use of inhaled corticosteroids is associated with an increased risk of pneumonia in people with COPD, but whether the same is true for people with asthma is not known.

Methods:  With the use of primary care data from The Health Improvement Network, we identified people with asthma, and from this cohort, we identified patients with pneumonia or lower respiratory tract infection and age- and sex-matched control subjects. Conditional logistic regression was used to determine the association between the dose and type of inhaled corticosteroid and the risk of pneumonia or lower respiratory tract infection.

Results:  A dose-response relationship was found between the strength of inhaled corticosteroid dose and risk of pneumonia or lower respiratory tract infection (P < .001 for trend) such that after adjusting for confounders, people receiving the highest strength of inhaled corticosteroid (≥ 1,000 μg) had a 2.04 (95% CI, 1.59-2.64) increased risk of pneumonia or lower respiratory tract infection compared with those with asthma who did not have a prescription for inhaled corticosteroids within the previous 90 days.

Conclusions:  People with asthma receiving inhaled corticosteroids are at an increased risk of pneumonia or lower respiratory infection, with those receiving higher doses being at greater risk. Pneumonia should be considered as a possible side effect of inhaled corticosteroids, and the lowest possible dose of inhaled corticosteroids should be used in the management of asthma.


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