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Scientific rationale for the possible inhaled corticosteroid intraclass difference in the risk of pneumonia in COPD
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research. AstraZeneca Nord, Resp Inflammat & Autoimmun, Sodertalje, Sweden.
AstraZeneca Gothenburg, Resp GMed, Molndal, Sweden.
Univ Nottingham, Nottingham Resp Res Unit, City Hosp Campus, Nottingham, England.
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2017 (English)In: The International Journal of Chronic Obstructive Pulmonary Disease, ISSN 1176-9106, E-ISSN 1178-2005, Vol. 12, p. 3055-3064Article, review/survey (Refereed) Published
Abstract [en]

Inhaled corticosteroids (ICSs) treatment combined with long-acting β2-adrenoceptor agonists (LABAs) reduces the risk of exacerbations in COPD, but the use of ICSs is associated with increased incidence of pneumonia. There are indications that this association is stronger for fluticasone propionate than for budesonide. We have examined systematic reviews assessing the risk of pneumonia associated with fluticasone propionate and budesonide COPD therapy. Compared with placebo or LABAs, we found that fluticasone propionate was associated with 43%–78% increased risk of pneumonia, while only slightly increased risk or no risk was found for budesonide. We have evaluated conceivable mechanisms which may explain this difference and suggest that the higher pneumonia risk with fluticasone propionate treatment is caused by greater and more protracted immunosuppressive effects locally in the airways/lungs. These effects are due to the much slower dissolution of fluticasone propionate particles in airway luminal fluid, resulting in a slower uptake into the airway tissue and a much longer presence of fluticasone propionate in airway epithelial lining fluid.

Place, publisher, year, edition, pages
2017. Vol. 12, p. 3055-3064
Keywords [en]
COPD, budesonide, fluticasone, inhaled corticosteroids, pneumonia
National Category
Respiratory Medicine and Allergy
Identifiers
URN: urn:nbn:se:uu:diva-342415DOI: 10.2147/COPD.S143656ISI: 000413470000002PubMedID: 29089754OAI: oai:DiVA.org:uu-342415DiVA, id: diva2:1184190
Available from: 2018-02-20 Created: 2018-02-20 Last updated: 2018-03-22Bibliographically approved

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