Source: International Congress 2014 – Different interesting issues in respiratory infections: 1
Disease area: Airway diseases, Respiratory infections

Abstract

Background It is well established that high dose inhaled steroids increase risk of pneumonia in COPD. As use of inhaled steroids rise, it poses a dilemma for practising physicians in patients with pneumonia. High mortality of patients with pneumonia at our hospital led to a retrospective audit, giving us an opportunity to look at steroid inhaler usage among them.Methods Patients with pneumonia admitted to Milton Keynes Hospital from 01.07.12 to 30.06.13 were audited. Data for age, sex, length of stay, co-morbidity, medication and outcome were collected.Results 49 patients were admitted with 55 episodes of pneumonia. 29 were male and 20 female. Median age was 73 years (18-86 years) and mean LOS of 19.7 days. 26 patients did not use any inhalers. 21 were on inhaled steroids of which 18 (86%) were on fluticasone/salmeterol, 2 (10%) on budesonide/formeterol and 1(4%) was on beclomethasone/formeterol combination. All patients on inhalers either had COPD, bronchiectasis, asthma or lung fibrosis. Mean LOS for those on fluticasone/salmeterol was 26.8 days compared to mean LOS of 14.5 days for all others. Overall mortality was 18 out of 49 patients (37%). In those on fluticasone/salmeterol it was 9 out of 18 (50%) while 11 out of 31(35%) not on inhalers died.Conclusion While limited by numbers, our audit did reveal a high prevalence of fluticasone/salmeterol usage among patients with pre-existing lung disease and pneumonia, with higher length of stay and mortality. Other large scale studies draw similar conclusion, warranting a review of inhaled steroid prescribing in patients who have had, or are susceptible to pneumonia.1. Janson et al; BMJ 2013; 346:33062. Suissa et al; Thorax 2013; 68: 1029-1036.

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T. Rehman, V. Somani, C. McGeary, R. Randhawa, A. Kavidasan, M. Bhattacharya (Milton Keynes, United Kingdom). Inhaled steroids in patients admitted to hospital with pneumonia. Eur Respir J 2014; 44: Suppl. 58, 2554

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