Late-Breaking Abstract: is Treatment with Inhaled Corticosteroids in Asthma Associated with Hospitalisations Because of Pneumonia?

Introduction: It is well known that using inhaled corticosteroids (ICS) in Chronic Obstructive Pulmonary Disease increases the risk of pneumonia, but less is known whether ICS treatment in asthma does the same. Aim: To examine risk factors for pneumonia in a population sample with special emphasis on asthma and the use of ICS in asthmatics. Methods: The Respiratory Health in Northern Europe (RHINE) II survey was conducted in 1999 to 2000 and included 6980 subjects from three Swedish centres, who answered a questionnaire including information on asthma, smoking, weight and height. Data on hospitalisations for pneumonia(HP) and treatment with ICS was collected from the Swedish National Patient Register and the Swedish Prescribed Drug Register. Cox and Poisson regressions were used in the analyses. Results: Asthma is a strong risk factor for HP (Hazard Ration (HR 2.89 (1.78-4.70)), others were smoking (HR 1.71) and a Body mass index(BMI) < 20 kg/m2 (HR 2.46) or a BMI > 30 kg/m2 (HR 2.13). Among asthmatics (n=587) continuous treatment with fluticasone proprionate was associated with an increased risk of HP(incidence risk ratio (IRR) 8.30 (2.32-29.7) whereas no significant association was found with the use of budesonide (IRR 1.08 (0.29-4.10)). Other risk factors for asthmatics were high level of symptoms (IRR 11.5) and having a BMI< 20 kg/m2 (IRR 10.1). Conclusion: Subjects with asthma have a three times higher risk of being hospitalized because of pneumonia than non-asthmatics. In asthmatics there is an intra-class difference between ICS compounds with fluticasone proprionate, but not budesonide, being associated with a higher risk of hospitalisations because of pneumonia.