Asthma: increased risk for severe pneumonia with inhaled corticosteroids

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  • In patients with asthma, current ICS use was associated with significantly increased risk of being hospitalized for pneumonia, especially with doses ≥500 µg of fluticasone-equivalent per day. 
  • The risk associated with budesonide (Pulmicort) and fluticasone (Flixotide) were similar.

Why this matters

  • It is known that ICS use increases risk for pneumonia in COPD, but findings in patients with asthma have been contradictory.
  • The present findings disagree with the conclusions of the only other study that directly assessed ICS and pneumonia risk in asthma. 
  • The finding of similar risk with budesonide and fluticasone conflict with previous findings of a higher risk with fluticasone.

Study design

  • Retrospective cohort study evaluated 152,412 patients with asthma between 1990 and 2007.
  • Funding: None.

Key results

  • 1928 patients had pneumonia during mean follow-up duration of 4.8 y.
  • Current ICS use was associated with 83% increased rate of hospitalizations due to pneumonia, dose equivalent to ≥500 mg fluticasone increased the risk by 96%.
  • Risk for pneumonia increased with use of budesonide (relative risk [RR], 2.67; 95% CI, 2.05-3.49), fluticasone (RR, 1.93; 95% CI, 1.58-2.36), but not with other ICS groups (RR, 1.23; 95% CI, 0.92-1.63).


  • Data on smoking and other environmental exposures were not available.