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      Pneumonia risk in COPD patients receiving inhaled corticosteroids alone or in combination: TORCH study results.

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          Abstract

          Inhaled corticosteroids (ICS) are important in reducing exacerbation frequency associated with chronic obstructive pulmonary disease (COPD). However, little is known about the risk of associated infections. In a post hoc analysis of the TOwards a Revolution in COPD Health (TORCH) study, we analysed and identified potential risk factors for adverse event reports of pneumonia in this randomised, double-blind trial comparing twice-daily inhaled salmeterol (SAL) 50 microg, fluticasone propionate (FP) 500 microg, and the combination (SFC) with placebo in 6,184 patients with moderate-to-severe COPD over 3 yrs. Despite a higher withdrawal rate in the placebo arm, after adjusting for time on treatment, a greater rate of pneumonia was reported in the FP and SFC treatment arms (84 and 88 per 1,000 treatment-yrs, respectively) compared with SAL and placebo (52 and 52 per 1,000 treatment-yrs, respectively). Risk factors for pneumonia were age > or =55 yrs, forced expiratory volume in 1 s <50% predicted, COPD exacerbations in the year prior to the study, worse Medical Research Council dyspnoea scores and body mass index <25 kg.m(-2). No increase in pneumonia deaths with SFC was observed; this could not be concluded for FP. Despite the benefits of ICS-containing regimens in COPD management, healthcare providers should remain vigilant regarding the possible development of pneumonia as a complication in COPD patients receiving such therapies.

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          Author and article information

          Journal
          Eur Respir J
          The European respiratory journal
          European Respiratory Society (ERS)
          1399-3003
          0903-1936
          Sep 2009
          : 34
          : 3
          Affiliations
          [1 ] GlaxoSmithKline, Research Triangle Park, NC 27709-3398, USA. courtney.c.crim@gsk.com
          Article
          09031936.00193908
          10.1183/09031936.00193908
          19443528
          40e6d825-851e-4058-8335-292af0e00f2b
          History

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