Inhaled corticosteroids and systemic inflammatory response in community‐acquired pneumonia: A prospective clinical study

Background and objective The previous use of inhaled corticosteroids ( ICS ) may reduce the inflammatory response and mortality in patients with community‐acquired pneumonia ( CAP ). Methods We measured serum levels of several inflammatory biomarkers, as well as mortality at various time‐points, in 663 consecutive patients hospitalized for CAP ; 128 (19%) were receiving chronic outpatient treatment with ICS . Patients on previous oral corticosteroids were excluded from the analysis. Results On admission, patients treated with ICS were older; had been diagnosed with chronic obstructive pulmonary disease ( COPD ), asthma and pneumonia in the previous year more often; and had higher CAP severity risk classes and lower tumour necrosis factor ( TNF )‐alpha ( P  < 0.001) and interleukin ( IL )‐6 ( P  = 0.015) serum levels. After adjusting for potential confounders, this association persisted for TNF ‐alpha ( P  < 0.001), but not for IL ‐6. Mortality at 30 and 90 days tended to be lower in patients treated with ICS ( P  = 0.062 and 0.050, respectively), but mortality was similar after 1 year in both groups (16, 13% vs 81, 15% for patients treated and not treated with ICS , respectively). Hospital readmission rate after 1 year was higher in patients treated with ICS (49, 38% vs 109, 20%, P  < 0.001). The association of ICS treatment with a previous diagnosis of pneumonia, lower levels of TNF ‐alpha and IL ‐6 on admission and higher readmission rates during follow up persisted in the subpopulation of 210 patients with COPD . Conclusions Previous use of ICS in patients hospitalized for CAP is associated with a reduced systemic inflammatory response without any impact on long‐term mortality.