A University of Alberta researcher says health professionals should be cautious about prescribing inhaled corticosteroids to high-risk patients such as pneumonia survivors, citing a twofold risk for repeat infection.
Dean Eurich led a research team that examined inhaled corticosteroid use among elderly patients for a clinical study. The team evaluated more than 6,200 seniors who survived an initial episode of pneumonia but were still at high risk of developing another bout of infection.
Over the five-year study, 653 seniors had a repeat episode -- and inhaled corticosteroid use was associated with a 90 per cent increase in risk for these repeat occurrences compared with the rate among those not using the drugs.
"Given the evidence starting to emerge on inhaled corticosteroids, health professionals have to use their own clinical judgement to try and determine which patients should remain on the drugs, especially for patients with pneumonia," said Eurich, an associate professor in the School of Public Health and trained pharmacist.
Inhaled corticosteroids are used to treat asthma and chronic obstructive pulmonary disease -- chronic bronchitis and emphysema -- as well as other respiratory disorders such as a nagging cough. Several smaller studies have examined the risk of developing pneumonia, but the U of A team is the first to look at such a large group of high-risk seniors.
More research is needed as to why these drugs pose a greater pneumonia risk, but for patients taking them, Eurich has healthy advice: listen to your health professional, wash your hands often and get vaccinated to reduce your risk of respiratory infections.
"Continue on your medications as your health professional has told you to use them. If you're feeling unwell, if you are coughing or wheezing more, are more short of breath than usual, have chest pain when breathing deeply or coughing, feel fatigued, or develop a fever, see a physician sooner rather than later."
Research begins at bedside
Eurich says the new findings would not have been possible without talented collaborators such as Alberta Diabetes Institute colleague Sumit Majumdar of the Faculty of Medicine & Dentistry and the faculty's former dean, Tom Marrie, now at Dalhousie University, as well as data and support from Alberta Health and Alberta Health Services.
"When we set up this cohort, there was a ton of support from the University of Alberta and because there's such a good relationship between the university and the health system, it easily facilitated our work," he said. "When researchers have access to data for population-based studies, we can look at safety issues with medications in real-world patients."
The research was published last month in the peer-reviewed journal Clinical Infectious Diseases.
- D. T. Eurich, C. Lee, T. J. Marrie, S. R. Majumdar. Inhaled Corticosteroids and Risk of Recurrent Pneumonia: A Population-Based, Nested Case-Control Study. Clinical Infectious Diseases, 2013; DOI: 10.1093/cid/cit472
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