COPD, inhaled steroids, and pneumonia.

Inhaled steroids ‘increase pneumonia risk’, major trial suggests – said the headline in the Pulse newsletter this morning.

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Well, maybe, but first of all – do not panic, and do not stop taking your steroid inhaler.

You can read a summary of the report here, which says that inhaled steroids result in an increased risk of pneumonia and death in patients with COPD (however, when you’ve read through the scary stuff, you come to this qualifying statement – “I would be concerned about patients who are immunocompromised or with diabetes.”. So, clearly not everybody, then. Also, the percentages given for the risks are meaningless – what are they a percentage of ? It simply doesn’t say, and without knowing that they’re useless. Let’s say, for example, that the normal risk is 1 in 10,000. A 57% increase, as in one of the groups in the study, comes out at less than 2 in 10,000, which frankly, is not a cause for worry. These are MY figures, though, to illustrate how meaningless a percentage is if you don’t know the base figure.

As you can see, this is based on meta-analysis, i.e., add up the numbers from other people’s research and apply your own parameters to get the results you’re looking for. As I’ve said previously, I don’t like meta-analysis, as it often pays little or no heed to the quality of the original research – it is certainly no substitute for original, patient-based research.

Based on my personal experience, and I’ve been taking inhaled steroids for the better part of 30 years (maybe more), I haven’t been especially prone to pneumonia nor, obviously, has it increased my mortality. I have had all levels of COPD and all levels of inhaled steroids and, although I have had pneumonia a few times, to be realistic, given the state of my lungs, and my susceptibility to infection, it would be surprising if I had not contracted pneumonia.

If this report worries you – and it probably shouldn’t as it’s not actually proof of anything, it’s an indication that more, proper research is needed, in my view (and I consider myself an expert patient when it comes to COPD and its treatment – I have more experience of it than most GPs) – then, as I said, DON’T stop taking your steroid inhaler, but talk to your GP and/or consultant. Given the benefits of inhaled steroids I’ll take the risk (whatever it actually is), at least until better research comes along. My worry, though, is that some GPs might be tempted to withdraw patients’ steroid inhalers based on this report, and that would be potentially very dangerous.

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