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BMJ 2009; 338 doi: (Published 17 February 2009) Cite this as: BMJ 2009;338:b627

Inhaled steroids linked to pneumonia in people with COPD

Inhaled corticosteroids are associated with an increased risk of pneumonia in people with chronic obstructive pulmonary disease (COPD), according to a meta-analysis. The extra episodes of pneumonia don’t seem to threaten survival, however. In a pooled analysis of 18 randomised trials, people using inhaled steroids were 60% more likely to get pneumonia than controls (relative risk 1.6, 95% CI 1.33 to 1.92) and 71% more likely to get serious pneumonia (1.71, 1.46 to 1.99), but they were no more likely to die of pneumonia or anything else. Combined treatment with inhaled steroids and the long acting β agonist salmeterol was also associated with significantly more pneumonia than treatment with salmeterol alone (1.68, 1.2 to 2.34).

The 16 996 patients in these trials took their assigned treatment for at least 24 weeks. Most trials tested fluticasone propionate alone or combined with salmeterol. Two trials tested inhaled budesonide. The authors estimated one extra episode of serious pneumonia would occur for every 47 (34 to 73) patients treated long term with inhaled steroids.

This isn’t the first analysis to find a clinically important link between inhaled steroids and pneumonia in this patient group, say the authors. Local immunosuppression within the lung is one biologically plausible explanation.

Extra payments help employees to stop smoking

Experts estimate that employees who stop smoking save their employers around $3400 (£2380; €2600) a year in reduced time off sick and increased productivity. So paying employees to stop smoking might save money, if it works. Small trials have reported inconsistent results. In a recent large trial, however, financial incentives of up to $750 helped one US corporation’s smokers to quit for up to 18 months. Employees given the extra payments were more likely to attend and complete a smoking cessation programme, more likely to quit short term (20.9% (91/436) v 11.8% (52/442); P<0.001), and then …

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