The researchers found no significant difference in the one-year death rate from research involving more than 4,600 patients who used the inhalers versus a similar number of patients who did not.
More patients were included in studies that examined the risk of pneumonia, however. The number of pneumonia of cases was about a third higher in those who used the inhalers compared to those who didn't.
A total of 777 of the 5,405 patients who used the inhalers developed pneumonia, compared to 561 of 5,371 patients who did not, the Johns Hopkins team noted.
Up to 15 million Americans currently have some form of COPD, Drummond said, "and it's estimated that about half of those use inhaled steroids. You're looking at six million people who may be exposed to this 34 percent increase in risk."
While there's "clearly a benefit in some patients" who report that they feel better while using inhalers, the drugs aren't for everyone, Drummond said.
It's not clear why the inhalers may boost the risks of pneumonia, he said, but they may suppress the immune system in the lungs.
Dr. Norman H. Edelman, chief medical officer of the American Lung Association, said the review reflects existing beliefs about the use of these devices
"We already have accepted that inhaled steroids increase the risk of pneumonia in COPD patients," he said. "All medication decisions involve a risk/benefit analysis. Doctors should keep the risk in mind and weigh it against actual benefits, always in full consultation with the patient, who should make the ultimate decision."
There's more on COPD at the U.S. National Heart, Lung, and Blood Institute.
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