Patients ages 65 years or older who've survived an initial episode of community-acquired pneumonia are known to be at increased risk for pneumonia recurrence.

In a prospective population-based study, researchers examined the relationship between a recurrence of pneumonia and the use of inhaled corticosteroids in 2,479 such patients, 656 of whom experienced a recurrence (the mean time to recurrence was 1.4 years). Of these 656 patients, 653 were successfully matched to 6,244 controls (a nearly 10-to-one ratio) for age, sex, chronic obstructive pulmonary disease (COPD) history, and use of inhaled corticosteroids. Patients and controls were similar, although the 653 patients included in the analysis had had more-severe initial pneumonia and were therefore more likely to have been admitted to the hospital.

Among the study patients, 19% (123) were current corticosteroid users (had used a corticosteroid within 90 days before pneumonia recurrence), compared with 12% (747) in the control group.

The relative risk of pneumonia recurrence was almost two times higher among the current corticosteroid users (14%) than among those who didn't use inhaled corticosteroids (9%). Past corticosteroid use wasn't associated with an increased risk of recurrence.

These results held up after sensitivity analyses exploring factors such as matching just one control to each study patient and restricting the analysis to patients with a history of COPD or patients requiring hospitalization.

The authors were unable to examine dose response or determine differences between specific agents, but they conclude that the study results should be taken into account when determining corticosteroid use after an episode of pneumonia and in identifying patients who should be followed more closely after recovery.

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