Pneumonia among COPD patients using inhaled corticosteroids and long-acting bronchodilators

Prim Care Respir J. 2010 Jun;19(2):109-17. doi: 10.4104/pcrj.2009.00072.


Aim: To assess the risk of pneumonia among COPD patients using salmeterol/fluticasone propionate combination inhalers (SFC), inhaled corticosteroids (ICS), or long-acting beta-agonists (LABA), alone or in combination, compared to those using only short-acting bronchodilators (SABD).

Method: The study population comprised 5245 individuals using inhaled treatment for COPD, identified from the databases of three large regional managed care organisations from different parts of the USA. Longitudinally-collected administrative data were obtained on their clinical histories and treatments. Nested case-control methods were used to calculate adjusted odds ratios (OR) for the risk of pneumonia while on therapy.

Results: 2154 patients had at least one diagnosed case of pneumonia between 1st September 2001 and 31st August 2003. Relative to SABD, the only treatment associated with a non-significant increased risk of pneumonia was ICS used alone (OR=1.29; 95%CI: 0.96-1.73; p=0.09). Users of LABA alone (OR=0.92; 95%CI: 0.69-1.22) or SFC (OR=1.03; 95%CI: 0.74-1.42) had no increased risk for pneumonia relative to SABD. Advanced age and severity of lung disease were strongly associated with increased risk for pneumonia.

Conclusion: Treatment with ICS or an ICS/LABA combination inhaler was not associated with a significantly increased risk of developing pneumonia.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Administration, Inhalation
  • Adrenal Cortex Hormones / administration & dosage
  • Adrenal Cortex Hormones / adverse effects
  • Adrenal Cortex Hormones / therapeutic use*
  • Adult
  • Age Factors
  • Aged
  • Albuterol / administration & dosage
  • Albuterol / adverse effects
  • Albuterol / analogs & derivatives
  • Albuterol / therapeutic use
  • Androstadienes / administration & dosage
  • Androstadienes / adverse effects
  • Androstadienes / therapeutic use
  • Bronchodilator Agents / administration & dosage
  • Bronchodilator Agents / adverse effects
  • Bronchodilator Agents / therapeutic use*
  • Case-Control Studies
  • Delayed-Action Preparations / adverse effects
  • Drug Therapy, Combination / adverse effects
  • Female
  • Fluticasone
  • Humans
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Odds Ratio
  • Pneumonia / etiology*
  • Pulmonary Disease, Chronic Obstructive / complications
  • Pulmonary Disease, Chronic Obstructive / drug therapy*
  • Risk Factors
  • Salmeterol Xinafoate
  • Severity of Illness Index


  • Adrenal Cortex Hormones
  • Androstadienes
  • Bronchodilator Agents
  • Delayed-Action Preparations
  • Salmeterol Xinafoate
  • Fluticasone
  • Albuterol