ReviewAmerican journal of respiratory and critical care medicine2015
Incident pneumonia and mortality in patients with chronic obstructive pulmonary disease. A double effect of inhaled corticosteroids?
Review in American journal of respiratory and critical care medicine, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 35 papers, 5 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
35 citing papers in PubMed, 5 syntheses or guidelines pooled it, 66 citations in OpenAlex.
- Long-acting muscarinic antagonist (LAMA) plus long-acting beta-agonist (LABA) versus LABA plus inhaled corticosteroid (ICS) for stable chronic obstructive pulmonary disease.The Cochrane database of systematic reviews · 2023Pooled it
- Intraclass Difference in Pneumonia Risk with Fluticasone and Budesonide in COPD: A Systematic Review of Evidence from Direct-Comparison Studies.International journal of chronic obstructive pulmonary disease · 2020Pooled it
- Pooled it
- Joint statement for the diagnosis, management, and prevention of chronic obstructive pulmonary disease for Gulf Cooperation Council countries and Middle East-North Africa region, 2017.International journal of chronic obstructive pulmonary disease · 2017Guideline
- Pooled it
- Effect of a Combination ofNutrients · 2024Trial
- Risk of Exacerbation and Pneumonia with Single-Inhaler Triple versus Dual Therapy in IMPACT.Annals of the American Thoracic Society · 2021Trial
- Concomitant inhaled corticosteroid use and the risk of pneumonia in COPD: a matched-subgroup post hoc analysis of the UPLIFT® trial.Respiratory research · 2018Trial
- Fluticasone propionate/formoterol for COPD management: a randomized controlled trial.International journal of chronic obstructive pulmonary disease · 2017Trial
- The EFFECT trial: evaluating exacerbations, biomarkers, and safety outcomes with two dose levels of fluticasone propionate/formoterol in COPD.International journal of chronic obstructive pulmonary disease · 2015Trial
- Review
- Delta Neutrophil Index and Other Hematologic Parameters in Acute Exacerbations of COPD: A Retrospective Study.Canadian respiratory journal · 2025Article
- Article
- Multi-systemic melioidosis.World journal of clinical cases · 2024Article
- Multi-systemic melioidosis in a patient with type 2 diabetes in non-endemic areas: A case report and review of literature.World journal of clinical cases · 2024Article
- Non-typeableEuropean respiratory review : an official journal of the European Respiratory Society · 2022Review
- Inhaled Corticosteroids in Chronic Obstructive Pulmonary Disease: Benefits and Risks.Clinics in chest medicine · 2020Review
- Can Daily Walking Alone Reduce Pneumonia-Related Mortality among Older People?Scientific reports · 2020Article
- The association of delta neutrophil index with the prognosis of acute exacerbation of chronic obstructive pulmonary disease.BMC pulmonary medicine · 2020Article
- The IMPACT of tripleBreathe (Sheffield, England) · 2018Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
2 authors at 2 institutions in 1 country.
Funding
Abstract
Inhaled corticosteroids are commonly prescribed for patients with severe chronic obstructive pulmonary disease. Although their use improves quality of life and reduces exacerbations, it is associated with increased risk of pneumonia. Curiously, their use has not been associated with increased risk of pneumonia-related or overall mortality. We review pertinent literature to further explore the effects of inhaled corticosteroids on incident pneumonia and mortality in patients with chronic obstructive pulmonary disease. The association of use of inhaled corticosteroids and incident pneumonia is substantial and has been present in the majority of the studies on the topic. This includes both randomized controlled trials and observational studies. However, all of the studies have substantial risk of bias. Most randomized trials are limited by lack of systematic ascertainment of pneumonia; they depended on adverse event reporting. Many observational studies included proper radiographic assessment of pneumonia, but they are limited by their retrospective, observational design. The unadjusted higher risk of pneumonia is associated with longer duration of use, more potent ICS compounds, and higher doses. That implies a dose-effect relationship. Unlike pneumonia, mortality is a precise outcome. Despite the robust association of inhaled corticosteroid use with increased risk of pneumonia, all studies find either no difference or a reduction in pulmonary-related and overall mortality associated with the use of inhaled corticosteroids. These observations suggest a double effect of inhaled corticosteroids (i.e., an adverse effect plus an unexplained mitigating effect).
Indexed as
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.