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To the Editor: Dr Drummond and colleagues¹ presented a systematic review and data from a meta-analysis of 11 randomized trials evaluating fluticasone, triamcinolone, and budesonide, alone or in combination with other inhaled drugs (usually salmeterol), in the maintenance treatment of COPD. Of these studies, 7 reported pneumonia outcomes and were used for a secondary analysis, which indicated that inhaled corticosteroids were associated with a significant 34% increase in pneumonia risk (relative risk [RR], 1.34; 95% confidence interval [CI], 1.03-1.75).

The analysis of pneumonia risk included only 2 COPD studies with budesonide.^2-3 Given the risks for these 2 studies shown in Table 2, a subgroup analysis may not indicate an increased pneumonia risk for budesonide or the combination of budesonide/formoterol. The conclusion of the article may not apply to all inhaled corticosteroids or combinations of inhaled corticosteroids and long-acting β₂-agonists.

Financial Disclosures: Dr Radner reported being employed by AstraZeneca, which . . . [Full Text of this Article]

Finn Radner, PhD
finn.radner@astrazeneca.com

Ulf Nihlén, MD, PhD
AstraZeneca Research and Development
Lund, Sweden

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