Inhaled corticosteroids and risk of influenza in patients with asthma: a meta-analysis of randomized controlled trials
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REVIEW
Inhaled corticosteroids and risk of influenza in patients with asthma: a meta‑analysis of randomized controlled trials Hong Chen1 · Zhibo Xu1 · Jing Yang2 · Lan Huang1 · Ke Wang2 Received: 28 April 2020 / Accepted: 17 August 2020 © Springer Nature Switzerland AG 2020
Abstract Background It was reported that inhaled corticosteroids (ICS) treatment may affect local immunity and microbial community of the airway. However, whether ICS treatment increases the risk of influenza in patients with asthma remains unclear. This meta-analysis aimed to compare the risk of influenza between ICS and non-ICS treatment in patients with asthma. Methods PubMed, Embase, Cochrane Library and Clinical Trials.gov were searched from inception until November 2019. Randomized controlled trials (RCTs) were included that compared ICS treatment with non-ICS treatment on the risk of influenza in patients with asthma. Meta-analyses were conducted by the Peto approach and Mantel–Haenszel approach with corresponding 95% CIs. Results Nine trials involving 6486 patients were included in this meta-analysis. The risk of influenza was not different between ICS treatment and the control groups (Peto OR: 1.01, 95% CI 0.74–1.37, P = 0.95). The results of subgroup analyses based on durations (long-term and short-term treatment), doses (high-, medium- and low-dose treatment) and types (fluticasone and budesonide treatment) of ICS were consistent with the above pooled results. Moreover, subgroup analysis based on patients’ age also revealed that use of ICS did not increase the risk of influenza. Results of the two meta-analysis approaches were similar. Conclusions Use of ICS does not increase the risk of influenza in patients with asthma. This study adds to safety evidence of ICS as a regular controller treatment for patients with asthma. Keywords Inhaled corticosteroids (ICS) · Influenza · Asthma · Risk factors · Meta-analysis
Introduction Asthma is a common, chronic respiratory disease affecting 1–18% of the population in different countries. Inhaled corticosteroids (ICS) constitute the cornerstone of asthma treatment [1, 2]. Although ICS treatment is generally considered safe and well tolerated in patients, regular use of ICS may Electronic supplementary material The online version of this article (https://doi.org/10.1007/s40520-020-01688-9) contains supplementary material, which is available to authorized users. * Ke Wang [email protected] 1
Respiratory Diseases Laboratory, Chengdu Second People’s Hospital, No. 10 Qingyun South Street, Chengdu 610017, China
Department of Respiratory Medicine and Critical Care Medicine, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu 610041, China
2
affect local immunity and lead to respiratory infections of the patients [3]. Recently, ICS-related respiratory infections have been widely concerned. Development of pneumonia [4, 5], tuberculosis [6], and upper respiratory tract infection [7] due to daily use of ICS have been observed in patients with chronic obstructive pul
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