The National Health Security (NHS) prescribing advisers urge General Practitioners (GPs) to discuss the potential risks of adrenal suppression, osteoporosis, and pneumonia with all their patients who suffer from chronic obstructive pulmonary disease (COPD) and who might benefit from inhaled steroids. In the MeReC bulletin, GPs are recommended to look carefully at the risk-benefit of prescribing inhaled steroids for COPD patients after a research late last year showed that the drugs may be linked with an increased risk of pneumonia. In addition, the bulletin also recommends that GPs should factor in a recent study that showed anticholinergics were associated with an increased risk of all-cause and cardiovascular mortality in their treatment decisions.

According to the MeReC bulletin, when it comes to deciding treatment choices for COPD patients, recent safety concerns (from research and findings), potential benefits of treatments, potential side effects, and patients’ preference and budget should be taken into account. The bulletin particularly recommends that GPs should discuss the risk-benefit of inhaled corticosteroids with patients. Before adding inhaled steroid to the COPD patient’s treatment regimen, GPs should consider and discuss with their patient what the steroid risks are, particularly the potential increased risk of pneumonia and the risk of osteoporosis and other known and recently discovered side effects.

A GP in East Kilbride and member of the General Practice Airways, Dr. John Haughney, is of a dissenting opinion. He believes that GPs should wait for more definitive evidence of the risks of inhaled steroids and anticholinerics before alarming their patients unnecessarily. He thinks that the guidance that the NHS offered in the MeReC bulletin is written to be truthful academically but may not provide useful practical advice for GPs. He wonders who he can explain this to a patient in a meaningful way.

Inhaled corticosteroids are traditionally prescribed to patients with COPD to control the disease and keep it from worsening. A recent study, however, found that anti-inflammatory drugs such as corticosteroids can increase the chances of patients with COPD to contract pneumonia and be hospitalized. In the study, the researchers found a significant 70 percent increase in the risk of being hospitalized for pneumonia for a large number of patients prescribed with inhaled corticosteroids. The study also notes that the severest pneumonias that led to death within 30 days of being confined in the hospital, the risk with current inhaled steroids were also increased significantly.

The population-based study was published in the American Journal of Respiratory and Critical Care Medicine, which was published by the American Thoracic Society. The study was undergone by Dr. Pierre Ernst, a clinical epidemiologist at the McGill University in Canada, together with three other researchers from the same university and department of medicine. They analyzed the drug prescription information and hospitalization from 1988 to 2004 of a total of 175,906 patients with COPD who lived in Quebec, Canada. In their findings, 23,942 of the patients were hospitalized for pneumonia. With higher doses of inhaled steroids, the admission rate for pneumonia increased and once the medication was stopped, the reduction in risk was observed.

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