This Canadian study was designed as a case-control and followed a cohort of 175,000 patients during 1988–2003.
The adjusted rate ratio of hospitalization for pneumonia associated with current use of inhaled steroids was 1.70 and 1.53 for pneumonia hospitalization. The rate ratio of hospitalization for pneumonia was greatest with the highest doses of inhaled steroids, equivalent to fluticasone at 1,000 µg/day or more (rate ratio, 2.25).
The authors concluded that the use inhaled steroids was associated with an excess risk (70%) of pneumonia hospitalization among elderly patients with COPD.
Inhaled Corticosteroid Use in Chronic Obstructive Pulmonary Disease and the Risk of Hospitalization for Pneumonia. Ernst P et al. Am J Respir Crit Care 2007; 176: 162-166.