Table 1.

Summary of 6 systematic reviews, published from 2010 to 2016, addressing the risk of pneumonia associated with inhaled therapy containing treatment with inhaled fluticasone propionate or budesonide compared with placebo or LABAs in patients with COPD

Meta-analyses	Outcome	Fluticasone propionate			Budesonide			Comparator
		Studies (n)	Participants (n)	RR [95% CI]	Studies(n)	Participants (n)	RR [95% CI]
Singh and Loke (2010)18	All reported pneumonia events	16	15,624	RR =1.67 [1.47, 1.89]	7	6,561	RR =1.19 [0.92, 1.53]	LABA; placebo
Halpin et al (2011)19	Adverse pneumonia events	8	5,203	Log OR =0.669; variance =0.012	4	2,475	Log OR =−0.082; variance =0.061	Placebo
	Serious pneumonia adverse events	7	5,122	Log OR =0.651; variance =0.018	4	2,475	Log OR =−0.243; variance =0.128
Spencer et al (2011)20	Adverse pneumonia events	1	3,093	OR =1.43 [1.13, 1.81]	2	1,071	OR =0.84 [0.36, 1.96]	LABA
	Serious pneumonia adverse events	4	4,527	OR =1.46 [1.12, 1.92]	1	559	OR =2.42 [0.40, 20.16]
Nannini et al (2012)21	All reported pneumonia events	9	8,242	OR =1.75 [1.25, 2.45]	3	2,834	OR =1.09 [0.69, 1.73]	LABA
Nannini et al (2013)22	All reported pneumonia events	9	5,447	OR =1.76 [1.46, 2.14]	3	2,837	OR =0.92 [0.57, 1.47]	Placebo
Kew and Seniukovich (2014)23,a	All reported pneumonia events	11	15,377	OR =1.68 [1.49, 1.90]	6	7,011	OR =1.12 [0.83, 1.51]	LABA; placebo
	Serious pneumonia adverse events	17	19,504	OR =1.78 [1.50, 2.12]	7	6,472	OR =1.62 [1.00, 2.62]

Notes:

^aIn an indirect comparison, a higher risk of any pneumonia event (including less serious cases treated in the community) was found for fluticasone propionate than for budesonide (OR =1.86; 95% CI =1.04, 3.34). Meta-analyses identified by searching PubMed using the following search strategy: (Mesh Terms “chronic obstructive airway disease” OR “chronic obstructive lung disease” OR “chronic obstructive pulmonary disease” OR “pulmonary disease, chronic obstructive”) AND “pneumonia” [All Fields] AND “budesonide” [Mesh Term] AND “fluticasone” [Text Word] AND “review” [Publication Type] AND “English” [Language] AND “2010/01/01–2016/06/30” [Date – Publication]. Only articles based on a systematic literature search were included; if more than one systematic review from the Cochrane Library was identified during the time interval, only the last report was included. Studies that reported the “total” risk, ie, the risk of pneumonia due to treatment with ICS without separating the effect of different ICSs, were excluded. Of the 56 articles identified, 50 did not meet the inclusion criteria; the remaining 6 are summarized here.

Abbreviations: CI, confidence interval; ICS, inhaled corticosteroid; LABA, long-acting β₂-adrenoceptor agonist; OR, odds ratio; RR, risk ratio.