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

Abstract

CONTEXT: Inhaled corticosteroids (ICS) are associated with an increased risk of pneumonia in adult patients with chronic obstructive pulmonary disease. OBJECTIVE: To assess the association between ICS use and risk of pneumonia and other respiratory infections in children with asthma. DATA SOURCES: We searched PubMed from inception until May 2015. We also searched clinicaltrials.gov and databases of pharmaceutical manufacturers. STUDY SELECTION: We selected randomized trials that compared ICS with placebo for at least 4 weeks in children with asthma. DATA EXTRACTION: We included 39 trials, of which 31 trials with 11 615 patients contributed data to meta-analyses. RESULTS: The incidence of pneumonia was 0.58% (44/7465) in the ICS group and 1.51% (63/4150) in the placebo group. The meta-analysis of 9 trials that revealed at least 1 event of pneumonia revealed a reduced risk of pneumonia in patients taking ICS (risk ratio [RR]: 0.65; 95% confidence interval [CI]: 0.44 to 0.94). Using risk difference as effect measure, the meta-analysis including all 31 trials revealed no significant difference in the risk of pneumonia between the ICS and placebo groups (risk difference: –0.1%; 95% CI: –0.3% to 0.2%). No significant association was found between ICS and risk of pharyngitis (RR: 1.01; 95% CI: 0.87 to 1.18), otitis media (RR: 1.07; 95% CI: 0.83 to 1.37), and sinusitis (RR: 0.89; 95% CI: 0.76 to 1.05). LIMITATIONS: Lack of clearly defined criteria for respiratory infections and possible publication bias. CONCLUSIONS: Regular use of ICS may not increase the risk of pneumonia or other respiratory infections in children with asthma.