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).
Radner F, Nihlén U. Inhaled Corticosteroids in Patients With Chronic Obstructive Pulmonary Disease. JAMA. 2009;301(14):1432-1434. doi:10.1001/jama.2009.437