{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T05:59:44Z","timestamp":1790056784930,"version":"4.0.1"},"reference-count":111,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2016,2,18]],"date-time":"2016-02-18T00:00:00Z","timestamp":1455753600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Ther Adv Respir Dis"],"published-print":{"date-parts":[[2016,6]]},"abstract":"<jats:p> There is a considerable amount of evidence that supports the possibility of an increased risk of pneumonia associated with prolonged use of inhaled corticosteroids (ICS) in patients with chronic obstructive pulmonary disease (COPD). However, as yet, no statistically significant increase in pneumonia-related 30-day mortality in patients on ICS has been demonstrated. The lack of objective pneumonia definitions and radiological confirmations have been a major source of bias, because of the similarities in clinical presentation between pneumonia and acute exacerbations of COPD. One of the newer fluticasone furoate studies overcomes these limitations and also provides an assessment of a range of doses, suggesting that the therapeutic window is quite narrow and that conventional dosing has probably been too high, although the absolute risk may be different compared to other drugs. Newer studies were not able to rule out budesonide as responsible for pneumonia, as previous evidence suggested, and there is still need for evidence from head-to-head comparisons in order to better assess possible intra-class differences. Although the exact mechanisms by which ICS increase the risk of pneumonia are not fully understood, the immunosuppressive effects of ICS on the respiratory epithelium and the disruption of the lung microbiome are most likely to be implicated. Given that COPD represents such a complex and heterogeneous disease, attempts are being made to identify clinical phenotypes with clear therapeutic implications, in order to optimize the pharmacological treatment of COPD and avoid the indiscriminate use of ICS. If deemed necessary, gradual withdrawal of ICS appears to be well tolerated. Vaccination against pneumococcus and influenza should be emphasized in patients with COPD receiving ICS. Physicians should keep in mind that signs and symptoms of pneumonia in COPD patients may be initially indistinguishable from those of an exacerbation, and that patients with COPD appear to be at increased risk of developing pneumonia as a complication of ICS therapy. <\/jats:p>","DOI":"10.1177\/1753465816630208","type":"journal-article","created":{"date-parts":[[2016,2,19]],"date-time":"2016-02-19T04:07:54Z","timestamp":1455854874000},"page":"235-255","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":35,"title":["Inhaled corticosteroids and the increased risk of pneumonia: what\u2019s new? A 2015 updated review"],"prefix":"10.1177","volume":"10","author":[{"given":"Hernan","family":"Iannella","sequence":"first","affiliation":[{"name":"Hospital de Cl\u00ednicas \u2018Jos\u00e9 de San Martin\u2019, Universidad de Buenos Aires, Av. C\u00f3rdoba 2351, Ciudad de Buenos Aries, C1120AAR, Argentina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos","family":"Luna","sequence":"additional","affiliation":[{"name":"Hospital de Cl\u00ednicas \u2018Jos\u00e9 de San Martin\u2019, Universidad de Buenos Aires, Ciudad de Buenos Aires, Argentina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grant","family":"Waterer","sequence":"additional","affiliation":[{"name":"Royal Perth Hospital, University of Western Australia, Western Australia, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2016,2,18]]},"reference":[{"key":"bibr1-1753465816630208","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-2600(14)70227-9"},{"key":"bibr2-1753465816630208","doi-asserted-by":"publisher","DOI":"10.1016\/j.arbr.2015.02.002"},{"key":"bibr3-1753465816630208","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00095807"},{"key":"bibr4-1753465816630208","doi-asserted-by":"publisher","DOI":"10.1136\/thoraxjnl-2012-201772"},{"key":"bibr5-1753465816630208","doi-asserted-by":"publisher","DOI":"10.1080\/15412550903140881"},{"key":"bibr6-1753465816630208","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201108-1553OC"},{"key":"bibr7-1753465816630208","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(14)62447-8"},{"key":"bibr8-1753465816630208","doi-asserted-by":"publisher","DOI":"10.1136\/thx.2004.032516"},{"key":"bibr9-1753465816630208","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa063070"},{"key":"bibr10-1753465816630208","doi-asserted-by":"publisher","DOI":"10.1378\/chest.09-2992"},{"key":"bibr11-1753465816630208","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201012-2070OC"},{"key":"bibr12-1753465816630208","first-page":"CD002309","volume":"11","author":"Chong J.","year":"2013","journal-title":"Cochrane Database Syst Rev"},{"key":"bibr13-1753465816630208","doi-asserted-by":"publisher","DOI":"10.1016\/j.rmed.2012.03.008"},{"key":"bibr14-1753465816630208","doi-asserted-by":"publisher","DOI":"10.1513\/AnnalsATS.201409-413OC"},{"key":"bibr15-1753465816630208","doi-asserted-by":"publisher","DOI":"10.1378\/chest.14-1676"},{"key":"bibr16-1753465816630208","doi-asserted-by":"publisher","DOI":"10.1378\/chest.12-1684"},{"key":"bibr17-1753465816630208","doi-asserted-by":"publisher","DOI":"10.4187\/respcare.03036"},{"key":"bibr18-1753465816630208","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-2600(14)70028-1"},{"key":"bibr19-1753465816630208","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0097149"},{"key":"bibr20-1753465816630208","doi-asserted-by":"publisher","DOI":"10.1378\/chest.13-2137"},{"key":"bibr21-1753465816630208","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-2600(13)70040-7"},{"key":"bibr22-1753465816630208","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2008.717"},{"key":"bibr23-1753465816630208","unstructured":"Electronic Medicines Compendium (eMC) (2015a) Relvar Ellipta 184 micrograms\/22 micrograms inhalation powder, pre-dispensed. Updated 7 January 2015. www.medicines.org.uk\/emc\/medicine\/28495 (accessed 2 June 2015)."},{"key":"bibr24-1753465816630208","unstructured":"Electronic Medicines Compendium (eMC) (2015b) Seretide 100, 250, 500 Accuhaler. Updated 24 April 2015. www.medicines.org.uk\/emc\/medicine\/2317 (accessed 17 June 2015)."},{"key":"bibr25-1753465816630208","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.200611-1630OC"},{"key":"bibr26-1753465816630208","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00128914"},{"key":"bibr27-1753465816630208","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cit472"},{"key":"bibr28-1753465816630208","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.200203-183OC"},{"key":"bibr29-1753465816630208","doi-asserted-by":"publisher","DOI":"10.1053\/rmed.2000.0865"},{"key":"bibr30-1753465816630208","doi-asserted-by":"publisher","DOI":"10.1016\/j.rmed.2008.04.019"},{"key":"bibr31-1753465816630208","doi-asserted-by":"publisher","DOI":"10.1111\/resp.12324"},{"key":"bibr32-1753465816630208","doi-asserted-by":"publisher","DOI":"10.1016\/j.mayocp.2013.10.028"},{"key":"bibr33-1753465816630208","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199701233360402"},{"key":"bibr34-1753465816630208","doi-asserted-by":"publisher","DOI":"10.1136\/thoraxjnl-2012-201924"},{"key":"bibr35-1753465816630208","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2014.11432"},{"key":"bibr36-1753465816630208","unstructured":"GOLD (2011) Global Strategy for the Diagnosis, Management and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD) (updated January 2015). http:\/\/www.goldcopd.org (accessed 26 February 2015)."},{"key":"bibr37-1753465816630208","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00118909"},{"key":"bibr38-1753465816630208","doi-asserted-by":"publisher","DOI":"10.1111\/j.1742-1241.2011.02685.x"},{"key":"bibr39-1753465816630208","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.200912-1843CC"},{"key":"bibr40-1753465816630208","doi-asserted-by":"publisher","DOI":"10.1111\/j.1440-1843.2011.02076.x"},{"key":"bibr41-1753465816630208","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.00035-14"},{"key":"bibr42-1753465816630208","doi-asserted-by":"publisher","DOI":"10.1378\/chest.13-0488"},{"key":"bibr43-1753465816630208","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0909883"},{"key":"bibr44-1753465816630208","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.f3306"},{"key":"bibr45-1753465816630208","first-page":"587","volume":"7","author":"Jen R.","year":"2012","journal-title":"Int J Chron Obstruct Pulmon Dis"},{"key":"bibr46-1753465816630208","doi-asserted-by":"publisher","DOI":"10.1016\/S0091-6749(98)70155-1"},{"key":"bibr47-1753465816630208","doi-asserted-by":"publisher","DOI":"10.1016\/j.rmed.2009.10.002"},{"key":"bibr48-1753465816630208","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.200602-244OC"},{"key":"bibr49-1753465816630208","doi-asserted-by":"publisher","DOI":"10.1186\/s12931-015-0210-x"},{"issue":"3","key":"bibr50-1753465816630208","first-page":"CD010115","volume":"10","author":"Kew K.","year":"2014","journal-title":"Cochrane Database Syst Rev"},{"key":"bibr51-1753465816630208","first-page":"283","volume":"7","author":"Kitaguchi Y.","year":"2012","journal-title":"Int J Chron Obstruct Pulmon Dis"},{"key":"bibr52-1753465816630208","doi-asserted-by":"publisher","DOI":"10.1111\/joim.12067"},{"key":"bibr53-1753465816630208","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.159.9.941"},{"key":"bibr54-1753465816630208","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2009.435"},{"key":"bibr55-1753465816630208","unstructured":"Loke, (2011)"},{"key":"bibr56-1753465816630208","doi-asserted-by":"publisher","DOI":"10.1111\/ijcp.12120"},{"key":"bibr57-1753465816630208","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1407154"},{"key":"bibr58-1753465816630208","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00077509"},{"key":"bibr59-1753465816630208","doi-asserted-by":"publisher","DOI":"10.4104\/pcrj.2009.00072"},{"key":"bibr60-1753465816630208","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00040710"},{"key":"bibr61-1753465816630208","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(14)62410-7"},{"key":"bibr62-1753465816630208","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00118912"},{"key":"bibr63-1753465816630208","doi-asserted-by":"publisher","DOI":"10.1097\/MCP.0000000000000154"},{"key":"bibr64-1753465816630208","first-page":"CD006829","volume":"4","author":"Nannini L.","year":"2007","journal-title":"Cochrane Database Syst Rev"},{"key":"bibr65-1753465816630208","first-page":"CD006829","volume":"9","author":"Nannini L.","year":"2012","journal-title":"Cochrane Database Syst Rev"},{"key":"bibr66-1753465816630208","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0047926"},{"key":"bibr67-1753465816630208","first-page":"971","volume":"6","author":"Ni S.","year":"2014","journal-title":"J Thorac Dis"},{"key":"bibr68-1753465816630208","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201005-0694OC"},{"key":"bibr69-1753465816630208","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-2600(15)00106-X"},{"key":"bibr70-1753465816630208","doi-asserted-by":"publisher","DOI":"10.1136\/thorax.57.9.759"},{"key":"bibr71-1753465816630208","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.200305-648OC"},{"key":"bibr72-1753465816630208","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0047305"},{"key":"bibr73-1753465816630208","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.06.00139305"},{"key":"bibr74-1753465816630208","doi-asserted-by":"publisher","DOI":"10.2165\/00003495-200969050-00004"},{"key":"bibr75-1753465816630208","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.06.00131905"},{"key":"bibr76-1753465816630208","doi-asserted-by":"publisher","DOI":"10.1378\/chest.09-0821"},{"key":"bibr77-1753465816630208","doi-asserted-by":"publisher","DOI":"10.1186\/1465-9921-15-77"},{"key":"bibr78-1753465816630208","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00126814"},{"key":"bibr79-1753465816630208","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejphar.2011.08.022"},{"key":"bibr80-1753465816630208","doi-asserted-by":"publisher","DOI":"10.1186\/cc6922"},{"key":"bibr81-1753465816630208","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201209-1732OC"},{"key":"bibr82-1753465816630208","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.200703-417OC"},{"key":"bibr83-1753465816630208","doi-asserted-by":"publisher","DOI":"10.1016\/j.rmed.2011.07.020"},{"key":"bibr84-1753465816630208","doi-asserted-by":"publisher","DOI":"10.7326\/M15-0715"},{"key":"bibr85-1753465816630208","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(09)61250-2"},{"key":"bibr86-1753465816630208","doi-asserted-by":"publisher","DOI":"10.1093\/qjmed\/hcq023"},{"key":"bibr87-1753465816630208","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00077010"},{"key":"bibr88-1753465816630208","doi-asserted-by":"publisher","DOI":"10.1001\/archinternmed.2008.550"},{"key":"bibr89-1753465816630208","doi-asserted-by":"publisher","DOI":"10.1097\/MCP.0b013e328334c085"},{"key":"bibr90-1753465816630208","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00162414"},{"key":"bibr91-1753465816630208","doi-asserted-by":"publisher","DOI":"10.1159\/000213757"},{"key":"bibr92-1753465816630208","doi-asserted-by":"publisher","DOI":"10.1136\/thoraxjnl-2012-202709"},{"key":"bibr93-1753465816630208","doi-asserted-by":"publisher","DOI":"10.1136\/thoraxjnl-2012-202872"},{"key":"bibr94-1753465816630208","doi-asserted-by":"publisher","DOI":"10.1378\/chest.15-0627"},{"key":"bibr95-1753465816630208","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00081514"},{"key":"bibr96-1753465816630208","doi-asserted-by":"publisher","DOI":"10.2165\/00003495-200868140-00004"},{"key":"bibr97-1753465816630208","first-page":"73","volume":"7","author":"Tashkin D.","year":"2012","journal-title":"Int J Chron Obstruct Pulmon Dis"},{"key":"bibr98-1753465816630208","doi-asserted-by":"publisher","DOI":"10.1185\/03007995.2012.743459"},{"key":"bibr99-1753465816630208","first-page":"822","volume":"63","author":"Tomczyk S.","year":"2014","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"bibr100-1753465816630208","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2015.88"},{"key":"bibr101-1753465816630208","doi-asserted-by":"publisher","DOI":"10.1183\/16000617.00009014"},{"key":"bibr102-1753465816630208","doi-asserted-by":"publisher","DOI":"10.1136\/thoraxjnl-2015-207770.260"},{"key":"bibr103-1753465816630208","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.200707-973OC"},{"key":"bibr104-1753465816630208","first-page":"CD007891","volume":"5","author":"Welsh E.","year":"2013","journal-title":"Cochrane Database Syst Rev"},{"key":"bibr105-1753465816630208","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0075221"},{"key":"bibr106-1753465816630208","first-page":"461","volume":"87","author":"World Health Organization","year":"2012","journal-title":"Wkly Epidemiol Rec"},{"key":"bibr107-1753465816630208","doi-asserted-by":"publisher","DOI":"10.1002\/art.21568"},{"key":"bibr108-1753465816630208","doi-asserted-by":"publisher","DOI":"10.1136\/thx.2004.034280"},{"key":"bibr109-1753465816630208","doi-asserted-by":"publisher","DOI":"10.1016\/j.pupt.2013.04.004"},{"key":"bibr110-1753465816630208","doi-asserted-by":"publisher","DOI":"10.2147\/COPD.S42366"},{"key":"bibr111-1753465816630208","first-page":"1015","volume":"10","author":"Zhong N.","year":"2015","journal-title":"Int J Chron Obstruct Pulmon Dis"}],"container-title":["Therapeutic Advances in Respiratory Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/1753465816630208","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/1753465816630208","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/1753465816630208","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,2]],"date-time":"2025-03-02T18:35:48Z","timestamp":1740940548000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/1753465816630208"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,2,18]]},"references-count":111,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2016,6]]}},"alternative-id":["10.1177\/1753465816630208"],"URL":"https:\/\/doi.org\/10.1177\/1753465816630208","relation":{},"ISSN":["1753-4666","1753-4666"],"issn-type":[{"value":"1753-4666","type":"print"},{"value":"1753-4666","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,2,18]]}}}