A new study by researchers at the McGill University Health Centre (MUHC) has revealed that patients suffering from chronic obstructive pulmonary disease (COPD) – a combination of chronic bronchitis and emphysema – run an increased risk of pneumonia when they take inhaled corticosteroids. The study explores other therapeutic alternatives and helps physicians determine the most suitable treatment for this complicated disease.
“Inhaled corticosteroids are commonly prescribed to patients with COPD, yet there has been concern over whether they represent the best treatment,” says Dr. Pierre Ernst, a senior physician in the respiratory division of the MUHC, professor of medicine at McGill University, and lead author of the new research. “Because COPD is an airway disease, there is a tendency for physicians to prescribe inhaled corticosteroids as they would with asthma patients.”
Although inhaled corticosteroids represent a lifesaving treatment for asthma, their benefit to patients with COPD is less obvious. “Previous studies have suggested there is a small increase in the risk of cataracts and fractures in COPD patient who are prescribed inhaled corticosteroids,” notes Dr. Ernst. The new study assessed the risk of pneumonia with the use of inhaled corticosteroids in COPD patients.
Researchers identified COPD patients from Quebec, Canada, between 1988 and 2003 from administrative databases linking hospitalization and drug dispensing information. “Of the 175,906 COPD patients in Quebec followed during the study, 23,942 were hospitalized for pneumonia,” says Dr. Ernst. The rate of hospitalization for pneumonia was greatest with the highest doses of inhaled corticosteroids, equivalent to 1,000 mcg of fluticasone per day or more.
“Our data, published last month in the American Journal of Respiratory and Critical Care Medicine, clearly show that COPD patients have an excess risk of pneumonia when they take inhaled corticosteroids,” says Dr. Ernst. “We suggest that alternative therapies, which include long-acting bronchodilators and pulmonary rehabilitation, may be much more effective than inhaled corticosteroids in COPD patients.”
Chronic obstructive pulmonary disease (COPD) is comprised primarily of two related diseases, chronic bronchitis and emphysema, which result in chronic obstruction of the flow of air through the airways and out of the lungs. The obstruction generally is permanent and progressive over time. Although asthma is also a pulmonary disease in which there is obstruction to the flow of air out of the lungs, unlike COPD the obstruction is usually reversible. Between “attacks” of asthma the flow of air through the airways usually is good.
The Research Institute of the McGill University Health Centre (RI MUHC) is a world-renowned biomedical and health care hospital research centre. Located in Montreal, Quebec, the institute is the research arm of the MUHC, a university health centre affiliated with the Faculty of Medicine at McGill University. The institute supports over 500 researchers, nearly 1,000 graduate and postdoctoral students, and operates more than 300 laboratories devoted to a broad spectrum of fundamental and clinical research. The Research Institute operates at the forefront of knowledge, innovation and technology and is inextricably linked to the clinical programs of the MUHC, ensuring that patients benefit directly from the latest research-based knowledge. For further details visit the Research Institute website. www.muhc.ca/research