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Does ICS treatment increase the risk of pneumonia in asthma?
  1. Christer Janson
  1. Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
  1. Correspondence to Dr Christer Janson, Dep om Medical Sciences: Respiratory Medicine, Uppsala University, Uppsala, Sweden; christer.janson{at}

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Patients with asthma have an increased risk of being hospitalised for pneumonia. For example, in a study based on the Respiratory Health In Northern Europe data set, Ekbom et al found that adults with asthma had a more than three times higher risk (HR (3.35 (95% CI 1.97 to 5.02)) of hospitalisation for pneumonia than non-asthmatics.1 Kankaanranta et al also found a high incidence of pneumonia in people with asthma when using data from the National Finnish Register of Health Care.2 In that study, the incidence of pneumonia was higher in those with more severe asthma than in the group with non-severe disease. Likewise, Ekbom et al found that more symptomatic individuals with asthma were more likely to be hospitalised for pneumonia than those with fewer symptoms.1

International guidelines recommend that mild asthma should not be treated solely with short-acting β2-agonist (SABA). Instead, inhaled corticosteroids (ICS), often combined with a long-acting beta-2-agonist—formoterol—are now part of treating all severity stages in asthma.3 The rationale is that targeting inflammation is important as studies even in mild asthma have shown that treatment with ICS in combination with formoterol reduces severe exacerbations …

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  • Contributors This editorial commissioned to and written by the author.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests CJ has served in an advisory board and/or served as a speaker and/or participated in education arranged from AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Novartis, Orion and TEVA.

  • Provenance and peer review Commissioned; internally peer reviewed.

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