Inhaled corticosteroids and respiratory infections in children with asthma: A meta-analysis

Abstract

context: inhaled corticosteroids (ics) are associated with an increased risk of pneumonia in abstract adult patients with chronic obstructive pulmonary disease. objective: to assess the association between ics use and risk of pneumonia and other respiratory infections in children with asthma. data sources: we searched pubmed from inception until may 2015. we also searched clinicaltrials.gov and databases of pharmaceutical manufacturers. study selection: we selected randomized trials that compared ics with placebo for at least 4 weeks in children with asthma. data extraction: we included 39 trials, of which 31 trials with 11 615 patients contributed data to meta-analyses. results: the incidence of pneumonia was 0.58% (44/7465) in the ics group and 1.51% (63/4150) in the placebo group. the meta-analysis of 9 trials that revealed at least 1 event of pneumonia revealed a reduced risk of pneumonia in patients taking ics (risk ratio [rr]: 0.65; 95% confidence interval [ci]: 0.44 to 0.94). using risk difference as effect measure, the meta-analysis including all 31 trials revealed no significant difference in the risk of pneumonia between the ics and placebo groups (risk difference: -0.1%; 95% ci: -0.3% to 0.2%). no significant association was found between ics and risk of pharyngitis (rr: 1.01; 95% ci: 0.87 to 1.18), otitis media (rr: 1.07; 95% ci: 0.83 to 1.37), and sinusitis (rr: 0.89; 95% ci: 0.76 to 1.05). limitations: lack of clearly defined criteria for respiratory infections and possible publication bias. conclusions: regular use of ics may not increase the risk of pneumonia or other respiratory infections in children with asthma.