In Reply: Drs Loke and Singh hypothesize that a substantial proportion of the serious adverse events reported in the study by Burge et al1 may have been COPD exacerbations rather than pneumonia. Lack of explicit definitions of pneumonia may alter the observed association of inhaled corticosteroids with increased pneumonia rates. However, because inhaled corticosteroids reduce COPD exacerbation rates, this form of misclassification would tend to bias estimates of pneumonia risk toward the null, underestimating the actual risk of pneumonia associated with inhaled corticosteroids.
Drummond MB, Fan E. Inhaled Corticosteroids in Patients With Chronic Obstructive Pulmonary Disease—Reply. JAMA. 2009;301(14):1432-1434. doi:10.1001/jama.2009.438