Extract
In a recent article, Suissa [1] proposes several alternative hypotheses to explain the paradoxical effect of inhaled corticosteroids (ICS) in chronic obstructive pulmonary disease (COPD) patients, whereby these drugs can increase the risk of pneumonia and simultaneously reduce pneumonia mortality. In our opinion, the conclusion of the article, that pneumonia mortality is increased in COPD patients treated with ICS, both in observational and in randomised clinical trials (RCTs), is not supported by data and cannot be considered confirmed. Basically, the author maintains that this paradox can be explained by the small number of events in randomised clinical trials (RCTs) and selection bias in observational studies [1].
Abstract
Chronic use of ICS increases the risk of pneumonia in COPD patients, although this risk is not homogenous. This study confirms that the risk of pneumonia-related mortality in randomised clinical trials is not increased in patients treated with ICS. http://bit.ly/2Zod6us
Footnotes
Conflict of interest: P. Almagro reports grants from AstraZeneca and SEPAR, personal fees from Chiesi, Boehringer Ingelheim and GlaxoSmithKline, travel support from Rovi and Esteve, outside the submitted work.
Conflict of interest: P. Martinez-Camblor has nothing to disclose.
Conflict of interest: J.B. Soriano reports grants from Linde, travel support from Almirall, AstraZeneca, Boehringer Ingelheim, Chest, Chiesi, ERS, Gebro, Grifols, GSK, Lipopharma, Mundipharma, Novartis, Pfizer, RiRL, Rovi, Sandoz, SEPAR and Takeda, outside the submitted work.
- Received April 11, 2019.
- Accepted May 30, 2019.
- Copyright ©ERS 2019
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