Previous Inhaled Corticosteroid Use Decreases Likelihood of Pleural Effusion in CAP

In an observational study involving 3612 patients with community-acquired pneumonia, pleural effusion and empyema occurred significantly less frequently in those with previous use of inhaled corticosteroids.

Patients with chronic obstructive lung disease (COPD) who routinely use inhaled corticosteroids (ICS) are at increased risk for community-acquired pneumonia (CAP). However, studies suggest that for COPD patients who develop CAP, previous ICS use is associated with decreased mortality and decreased incidence of parapneumonic effusion (PPE) and empyema.

To examine this paradox, investigators conducted a prospective observational study involving consecutive immunocompetent adults treated for CAP at a Barcelona hospital between 1997 and 2008. Among these 3612 patients, 390 (11%) developed PPE. The incidence of PPE was significantly lower in previous ICS users than in nonusers (5% vs. 12%; P<0.001), as was the incidence of empyema (0.5 vs. 2%; P=0.012). Multivariate analysis revealed a lower risk for PPE, regardless of COPD status. Among the 263 patients who underwent thoracocentesis, previous ICS use was associated with higher pH, higher glucose concentrations, and lower lactate dehydrogenase and protein levels in the pleural fluid (for each, P0.02). Outcomes among those with PPE, including 30-day mortality, were similar between those with and without previous ICS use.

CITATION(S):

Sellares J et al. Influence of previous use of inhaled corticoids on the development of pleural effusion in community-acquired pneumonia. Am J Respir Crit Care Med 2013 Jun 1; 187:1241.