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Inhaled Corticosteroids and Respiratory Infections in Children With Asthma: A Meta-analysis

Cristine Cazeiro1, Cristina Silva2, Susana Mayer2

  • 1Postgraduate Program in Public Health.

Pediatrics
|February 26, 2017
PubMed

Insights

Inhaled corticosteroids (ICS) may not increase pneumonia risk in children with asthma. This meta-analysis found no significant association between ICS use and pneumonia or other respiratory infections in pediatric asthma patients.

Area of Science:

  • Pediatric Pulmonology
  • Pharmacology
  • Clinical Trials

Background:

  • Inhaled corticosteroids (ICS) are a cornerstone of asthma management in children.
  • Previous studies in adults with COPD suggested an increased pneumonia risk with ICS use.
  • The safety profile of ICS regarding respiratory infections in pediatric asthma patients requires thorough investigation.

Purpose of the Study:

  • To evaluate the association between the use of inhaled corticosteroids (ICS) and the risk of pneumonia in children diagnosed with asthma.
  • To assess the potential link between ICS therapy and other common respiratory infections in this pediatric population.

Main Methods:

  • A systematic literature search was conducted across PubMed, clinicaltrials.gov, and pharmaceutical databases up to May 2015.
  • Randomized controlled trials comparing ICS with placebo for at least four weeks in pediatric asthma patients were included.
  • Data from 39 trials, with 31 contributing to meta-analyses involving 11,615 children, were analyzed.

Main Results:

  • The overall incidence of pneumonia was lower in the ICS group (0.58%) compared to the placebo group (1.51%).
  • A meta-analysis of 9 trials indicated a reduced risk of pneumonia with ICS use (RR: 0.65; 95% CI: 0.44 to 0.94).
  • However, a meta-analysis of all 31 trials using risk difference showed no significant difference in pneumonia risk between ICS and placebo groups (RD: -0.1%; 95% CI: -0.3% to 0.2%). No significant associations were found for pharyngitis, otitis media, or sinusitis.

Conclusions:

  • The regular use of inhaled corticosteroids (ICS) does not appear to elevate the risk of pneumonia or other respiratory infections in children with asthma.
  • Limitations include a lack of clearly defined criteria for respiratory infections and potential publication bias.
  • Further research with standardized definitions is warranted to confirm these findings.
Abstract

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