Investigació Aplicada en Malalties Respiratòries

The results were presented at the American Thoracic 2012 International Conference

Prior treatment with inhaled corticosteroids in patients with respiratory disorders who develop community acquired pneumonia (CAP) is associated with a lower incidence and severity of parapneumonic effusion. That is the conclusion of a research funded by CIBERes and IDIBAPS led by Dr. Jacob Sellarés, MD, PhD, associate faculty member at the Hospital Clínic - IDIBAPS de Barcelona. The results were presented at the American Thoracic 2012 International Conference held in San Francisco on May, and were recently commented by the newspaper Diario Médico.

Long-term treatment with inhaled corticosteroids is associated with an elevated risk of CAP in patients with COPD. By contrast, use of inhaled corticosteroids is also associated with less CAP severity and a lower risk of pneumonia-related mortality. That is one of the reasons why the use of such drugs is at the heart of a scientific controversy. The objective of this study was to assess the influence of long-term use of inhaled corticosteroids on the incidence and severity of parapneumonic effusion in patients with different baseline respiratory disorders.

The study enrolled 3,602 consecutive patients with a diagnosis of CAP, 659 of them having respiratory disorders treated with inhaled corticosteroids before CAP was diagnosed. Patients with prior treatment with inhaled corticosteroids, compared with those without, had a significantly lower incidence of parapneumonic effusion (5% vs. 12%). Prior corticosteroid treatment was associated with a higher incidence of simple parapneumonic effusion (53% vs 30%) and a lower incidence of empyema (3% vs 16%), a severe form of parapneumonic effusion, compared with no prior corticosteroid treatment.

Pleural infection is common in patients with CAP and is associated with an increased mortality risk. The results presented by Dr. Jacob Sellarés show that previous treatment of respiratory disorders with inhaled corticosteroids may reduce the risk of developing this dangerous complication. Future randomized studies must clarify the potential preventive role of inhaled corticosteroids in preventing parapneumonic effusion in patients with high risk of CAP.