Inhaled Corticosteroids Boost Pneumonia Risk in COPD

Patty Johnson, a spokeswoman for GlaxoSmithKline, disagreed with the contention that Advair does not benefit people with COPD.

"The benefits of Advair for treating patients with COPD have clearly been established," Johnson said. "Advair reduces exacerbations of COPD by 30 percent."

Johnson noted that the finding that Advair increases the risk of pneumonia has been known and is covered on the product's package label and patient information insert. "Physicians need to look at the total benefit/risk profile for the product for all their patients," she said.

Dr. Norman Edelman, chief medical officer of the American Lung Association, noted the benefit of using steroids to treat COPD is still not clear.

"The issue is of importance as combinations of inhaled steroids and long-acting beta agonists are being increasingly marketed and used for COPD," Edelman said. "Advair is the main one now, Symbicort is likely to be approved for COPD by the FDA soon, and I am told another is on the way."

The most reasonable conclusion is that inhaled steroids do indeed increase pneumonia in COPD without increasing death from pneumonia, Edelman said.

"On the other hand, the combinations have been shown to decrease exacerbations of COPD and improve function," he said. "In addition, some data actually suggest, but do not prove, that they prolong life."

This study suggests that the beneficial effects of the combinations are due to the long-acting beta agonists -- bronchodilators -- and not the steroids and implies that the way to treat COPD is with these agents alone, Edelman said. "I am sure that we will see more analyses to this point," he added.

COPD is a major health problem worldwide, but researchers have yet to make the kind of progress made in other major causes of death, Edelman said.

"This may be because some have considered it to be a self-inflicted disease -- via cigarette smoking -- and not worthy of study, but that's unfair," he said. "Almost all smokers have been addicted as teenagers by a wealthy and voracious tobacco industry. Thus, more research focused on early detection and reversal of the lung destruction is needed."

More information

The National Heart, Lung and Blood Institute has more on COPD.

SOURCES: Sonal Singh, M.D., M.P.H., assistant professor, internal medicine, Wake Forest University Baptist Medical Center, Winston-Salem, N.C.; Norman Edelman, M.D., chief medical officer, American Lung Association, New York City; Katie Neff, spokeswoman, AstraZeneca, Wilmington, Del.; Patty Johnson, spokeswoman, GlaxoSmithKline, Philadelphia; Feb. 9, 2009, Archives of Internal Medicine

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