Inhaled steroids and pneumonia

Inhaled corticosteroids (ICS) have been around for a long time, and there is plentiful evidence for their effectiveness in asthma prevention. Some adult evidence has suggested that they carry an increased risk of pneumonia and other respiratory tract infections (RTIs), which would not be surprising given that steroids are immunosuppressant. A review and meta-analysis set out to investigate this in children, using data from a large series of trials of efficacy of ICS, which reliably reported adverse effects (Cazeiro C et al. Pediatrics 2017. doi:10.1542/peds.2016–3271). They were able to analyse 31 trials, involving a range of different steroid drugs, including an impressive 11 600 children. Pneumonia was rare at around 1%–2%, and in some trials there were no cases in either arm. Their conclusion was that ICS, if anything, actually appeared to protect from rather than cause pneumonia: the overall incidences were 0.58% in those who received ICS compared with 1.51% in controls. They also looked at the incidences of some other RTIs including pharyngitis and sinusitis, and found no differences.

The authors are rightly cautious in claiming …