• Douglas Mapel, Michael Schum, Marianne Yood, Jeffrey Brown, David Miller, and Kourtney Davis.
• Lovelace Clinic Foundation, Albuquerque, New Mexico 87106, USA. dmapel@comcast.net
• Prim Care Respir J. 2010 Jun 1; 19 (2): 109-17.

AimTo assess the risk of pneumonia among COPD patients using salmeterol/fluticasone propionate combination inhalers (SFC), inhaled corticosteroids (ICS), or long-acting beta-agonists (LABA), alone or in combination, compared to those using only short-acting bronchodilators (SABD).MethodThe study population comprised 5245 individuals using inhaled treatment for COPD, identified from the databases of three large regional managed care organisations from different parts of the USA. Longitudinally-collected administrative data were obtained on their clinical histories and treatments. Nested case-control methods were used to calculate adjusted odds ratios (OR) for the risk of pneumonia while on therapy.Results2154 patients had at least one diagnosed case of pneumonia between 1st September 2001 and 31st August 2003. Relative to SABD, the only treatment associated with a non-significant increased risk of pneumonia was ICS used alone (OR=1.29; 95%CI: 0.96-1.73; p=0.09). Users of LABA alone (OR=0.92; 95%CI: 0.69-1.22) or SFC (OR=1.03; 95%CI: 0.74-1.42) had no increased risk for pneumonia relative to SABD. Advanced age and severity of lung disease were strongly associated with increased risk for pneumonia.ConclusionTreatment with ICS or an ICS/LABA combination inhaler was not associated with a significantly increased risk of developing pneumonia.

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