Influence of previous use of inhaled corticoids on the development of pleural effusion in community-acquired pneumonia

Am J Respir Crit Care Med. 2013 Jun 1;187(11):1241-8. doi: 10.1164/rccm.201209-1732OC.


Rationale: Previous use of inhaled corticosteroids (ICS) in patients with chronic obstructive pulmonary disease has been associated with increased risk of community-acquired pneumonia. However, ICS have been associated with fewer pneumonia complications and decreased risk of pneumonia-related mortality.

Objectives: The objective of the study was to assess the influence of previous use of ICS on the incidence of parapneumonic effusion in patients with different baseline respiratory disorders.

Methods: We conducted a single-center cohort study of 3,612 consecutively collected patients diagnosed with community-acquired pneumonia. We assessed clinical, radiographic, and pleural-fluid chemistry and microbiologic variables. Patients were classified according to whether or not they received prior ICS treatment.

Measurements and main results: A total of 633 patients (17%) were treated with corticosteroids before the diagnosis of pneumonia (chronic obstructive pulmonary disease, 54%; asthma, 13%). Incidence of parapneumonic effusion was lower in patients with ICS use compared with non-ICS patients (5% vs. 12%; P < 0.001). After matching according to propensity scores (n = 640), prior treatment with corticosteroids was still significantly associated with a lower incidence of parapneumonic effusion (odds ratio, 0.40; 95% confidence interval, 0.23-0.69; P = 0.001) compared with patients without ICS treatment. Prior ICS treatment was associated with higher levels of glucose (P = 0.003) and pH (P = 0.02), and lower levels of protein (P = 0.01) and lactic acid dehydrogenase (P = 0.007) in the pleural fluid.

Conclusions: Prior treatment with ICS in a population of patients with different respiratory chronic disorders who develop pneumonia is associated with lower incidence of parapneumonic effusion.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Administration, Inhalation
  • Aged
  • Asthma / drug therapy
  • Community-Acquired Infections / epidemiology
  • Community-Acquired Infections / etiology*
  • Female
  • Follow-Up Studies
  • Glucocorticoids / administration & dosage
  • Glucocorticoids / adverse effects*
  • Humans
  • Incidence
  • Male
  • Pleural Effusion / chemically induced*
  • Pleural Effusion / epidemiology
  • Pneumonia / epidemiology
  • Pneumonia / etiology*
  • Prospective Studies
  • Pulmonary Disease, Chronic Obstructive / drug therapy
  • Risk Factors
  • Spain / epidemiology


  • Glucocorticoids