Inhaled Steroids Bring Greater Risk of Pneumonia

Steroid inhalers may raise pneumonia risks
Nov. 26, 2008

BALTIMORE, Nov. 26 (UPI) -- Steroid inhalers, commonly prescribed for people with pulmonary disease, can increase the risk of pneumonia, U.S. researchers said.

The Johns Hopkins University study also found that while inhalers helped, they did not extend a patient's life after a year of use, The Baltimore Sun reported Wednesday.

While medical experts have known for years that inhalers are effective in treating wheezing and breathlessness brought on by chronic obstructive pulmonary disease, doctors raised questions about steroid inhalers' side effects and whether they extended a patient's life, said the study's lead author, M. Bradley Drummond, a pulmonologist at the Johns Hopkins School of Medicine.

In the study, investigators examined 11 clinical trials, including 14,426 patients, comparing the incidence of pneumonia in those who used inhalers against those who did not.

Researchers said they weren't sure why inhalers increased the risk of pneumonia, but one theory is that they may weaken a person's immune system.

"Because these agents are so effective at controlling symptoms, we do feel there is a good role for inhaled steroids for treating COPD," Drummond said. "But for some patients there may be more harm than benefits."

Drummond said patients who use inhalers should not stop doing so, but talk with their physicians if they have concerns.

Common trade names for this class of drug in the US include Beclovent, Flovent, and Pulmicort, Aerobid and Azmacort.

For one example, using Flovent, also known generically as fluticasone, this is a fluoride based product. There would be an additive factor in that inhaler propellants have traditionally been fluoride based solutions (two chlorofluorocarbon propellants: trichlorofluoromethane and dichlorodifluoromethane).

People using these products should be closely monitored for respiratory function but adrenal insufficiency as well as immune and thyroid function and bone density.

It is not enough that the steroid use can impair immune and endocrine function but bone health as well, especially when the products have a higher than average percentage of fluoride compounds.

More likely than not the higher risk of pneumonia could be correlated with steroid induced immune suppression. Data show upper respiratory infection as a major side effect.

Calcium and DHEA may be depleted using these products also.

Inhaled steroids in the mouth promote Candida albicans(yeast)infections there and also disperse steroids throughout the body(absorbed via the mucous membrane).