Shih-Lung Cheng, 1,2 Kang-Cheng Su, 3 Hao-Chien Wang, 4, * Diahn-Warng Perng, 3, * Pan-Chyr Yang 4
1 Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, 2 Department of Chemical Engineering and Materials Science, Yuan Ze University, Zhongli City, Taoyuan County, 3 Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, 4 Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
*These authors contributed equally to this work
Purpose: Complications of pneumonia development in patients with chronic obstructive pulmonary disease (COPD) receiving inhaled corticosteroid (ICS) therapy have been documented. The aim of this study was to focus on clinical efficacy and the incidence of pneumonia between COPD patients receiving medium and high doses of ICS.
Patients and methods: This prospective, randomized study included COPD patients identified from three tertiary medical centers from 2010 to 2012. The patients were randomized into two groups: high dose (HD; fluticasone 1,000 µg + salmeterol 100 µg/day) and medium dose (MD; fluticasone 500 µg + salmeterol 100 µg/day). Lung function with forced expiratory volume in 1 second (FEV 1 ), forced vital capacity, and COPD-assessment test (CAT) were checked every 2 months. The frequency of acute exacerbations and number of pneumonia events were measured. The duration of the study period was 1 year.
Results: In total, 237 COPD patients were randomized into the two treatment arms (115 in the HD group, 122 in the MD group). The FEV 1 level was significantly improved in the patients in the HD group compared with those in the MD group (HD ± mL versus MD ± mL, P <) at the end of the study. CAT scores were markedly improved in patients using an HD compared to those using an MD (HD 13±5 versus MD 16±7, P =). There was a significant difference in the percentage of annual rates in acute exacerbations (HD versus MD , P <) between the two groups. The incidence of pneumonia was similar in the two groups (HD versus MD , P =).
Conclusion: COPD patients treated with high doses of ICS had more treatment benefits and no significant increases in the incidence in pneumonia. Higher-dose ICS treatment may be suitable for COPD therapy.
Keywords: chronic obstructive pulmonary disease, pneumonia, inhaled corticosteroids
The aim of this article is to bring less well recognised adverse effects of inhaled corticosteroids to the attention of prescribers. Whilst inhaled steroids have a more favourable side effect profile than systemic steroids, they are not free from adverse effects. The dose of inhaled steroids used should be carefully monitored, and kept at the lowest dose necessary to maintain adequate control of the patient’s disease process. Be particularly aware of the cumulative effect of co-prescribing various dose forms of corticosteroids (inhaled, intranasal, oral and topical preparations).