Inhaled Steroids in COPD: Is Risk for Pneumonia Really Higher?

Do inhaled corticosteroids elevate risk for pneumonia in patients with chronic obstructive pulmonary disease? Several clinical trials, observational studies, and meta-analyses suggest that they do, by as much as 70%. But, in other trials, researchers have reported lower risk, and previous meta-analyses have been criticized for methodological weaknesses, such as combining trials of inhaled budesonide with those of fluticasone.

Canadian researchers pooled patient-level data from seven large clinical trials in which more than 7000 patients with COPD were randomized to inhaled budesonide or placebo, with or without the long-acting β₂-agonist formoterol, for 6 to 12 months. In both groups, 3% of patients developed pneumonia; in 1% of budesonide r…