COPD: Cortisone promotes pneumonia

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People with severe chronic obstructive pulmonary disease (COPD) usually inhale cortisone. This reduces inflammatory processes and slows the progression of the disease. But there is a catch in the use of drugs: they make those affected more susceptible to pneumonia.

This has now been confirmed by the European Medicines Agency (EMA) after evaluating and comparing the results of various studies on the subject. COPD patients who regularly take inhaled corticosteroids (ICS) are therefore more likely to develop pneumonia than patients who have not taken any such medication.

Cortisone is still recommended

However, the results of the comparative study also show that the benefits of cortisone treatment still outweigh the benefits. Experts therefore recommend that they continue to be used in COPD patients with severely impaired lung function. The cortisone preparations should always be used in combination with other drugs and only in advanced stages of the disease. The corresponding package inserts with the product information should, however, explicitly point out the increased risk of pneumonia in the future, demand the authors of the overview study.

Curse and blessing of ICS therapy

As part of COPD therapy, so-called corticosteroids (also known colloquially as cortisone) inhibit inflammatory processes in the lungs that are typical of this disease. The active ingredients imitate the body's own hormone cortisol, which also has an anti-inflammatory effect in nature and thus slows down excessive immune reactions.

For treatment, COPD patients breathe in drugs such as budesonide or beclometasone with the help of so-called inhalers. However, the corticosteroids not only suppress the damaging inflammatory reactions in the lungs, but also inhibit immune cells that act against external intruders.Therefore, with regular use of cortisone preparations, the lungs are more susceptible to pathogens - and thus to pneumonia. Since COPD patients are already prone to frequent lung infections due to their illness, this is particularly problematic.

Be vigilant and vaccinate regularly

Doctors recommend COPD patients to get regular vaccinations against pneumococci and influenza viruses, which can cause pneumonia. The pneumococcal vaccination should be given every five years, and immunization against influenza viruses even annually.

In addition, doctors and patients should be vigilant in order to detect the onset of pneumonia as early as possible. The typical symptoms of pneumonia - such as fever, shortness of breath or cough - can easily be confused with an acute worsening of the underlying disease. With such so-called exacerbations, the COPD symptoms suddenly increase significantly.

Fourth leading cause of death

Apart from simple cold infections, COPD is the most common disease of the respiratory system. It is estimated that around 14 percent of the world's population is affected.

In this disease, the small airways in the lungs (bronchioles) are constantly inflamed. Lung tissue changes as the disease progresses. This increasingly worsens the respiratory function. The therapy options currently available delay the course of the disease, but cannot stop or even reverse it. This is why COPD is now the fourth leading cause of death worldwide. The main triggers include inhaled toxins, especially cigarette smoke. For this reason, COPD is also known colloquially as "smoker's lung". (mg)

Source: Press release "Review confirms increased risk of pneumonia under therapy with inhaled corticoids in COPD" by the European Medicines Agency (EMA) from March 18, 2016

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