Long-term use of inhaled corticosteroids and risk of upper respiratory tract infection in chronic obstructive pulmonary disease: a meta-analysis

Abstract

Recent studies have suggested that inhaled corticosteroids (ICS) may be associated with higher risks of tuberculosis and pneumonia in patients with COPD. However, it is not known whether ICS increases the risk of upper respiratory tract infection (URTI). Aim of this study was to explore the relationship between ICS and URTI. Through a comprehensive literature search of PubMed, EMBASE, Cochrane Library, and Google Scholar from inception to March 2016, we identified randomized controlled trials of ICS therapy lasting at least 6 months. A meta-analysis by the Peto approach was also conducted to generate summary estimates comparing ICS with non-ICS treatment on the risk of URTI. A total of 14 studies involving 19,777 subjects were considered in the meta-analysis. Compared with non-ICS treatment, ICS were associated with a significantly increased risk of URTI (Peto OR: 1.16; 95% CI: 1.05–1.29; I² = 9%; p = .004). Subgroup analyzes were performed for different dose, high-dose ICS was associated with a significantly increased risk of URTI (Peto OR: 1.19; 95% CI: 1.05–1.34; I² = 0%; p = .005), whereas low-dose ICS showed a non-significant increased risk of URTI (Peto OR: 1.10; 95% CI: 0.91–1.33; I² = 0%; p = .32). Moreover, fluticasone was observed with an increased risk of URTI but not mometasone; high-dose fluticasone treatment was associated with a significantly higher risk of URTI but not low-dose. These results suggested to us that ICS use may increase the risk of URTI in patients with COPD, but it should be further investigated.

Keywords:

• Inhaled corticosteroids (ICS)
• chronic obstructive pulmonary disease (COPD)
• upper respiratory tract infection (URTI)
• risk
• meta-analysis

Acknowledgements

The authors are indebted to all members of the Respiratory Diseases Laboratory of Chengdu Second People’s Hospital. We are particularly grateful to Hong Chen, Yan Zhang, Yuejun Du, and Zhibo Xu for excellent technical assistance. Financial Support: Natural Science Foundation of China, Project Grant Numbers: 81650003. Chengdu Science and Technology Project, Project Application Numbers: 2015-HM0100621-SF. The funding bodies had no role in the study design, manuscript writing, or decision to submit the manuscript for publication.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

Financial Support: Natural Science Foundation of China, Project Grant Numbers: 81650003. Chengdu Science and Technology Project, Project Application Numbers: 2015-HM0100621-SF.