Public Release: 

Long-term ICS use reduces pleural effusion in patients with CAP

American Thoracic Society

ATS 2012, SAN FRANCISCO - Prior treatment with inhaled corticosteroids in patients with respiratory disorders who develop community acquired pneumonia (CAP) is associated with a lower incidence and severity of parapneumonic effusion, according to a new study from researchers in Spain.

A parapneumonic effusion is a type of pleural effusion (excess fluid that accumulates between the two pleural layers, the fluid-filled space that surrounds the lungs) that arises as a result of a pneumonia, lung abscess, or bronchiectasis.

"Long-term treatment with inhaled corticosteroids is associated with an elevated risk of CAP in patients with COPD, while at the same time, use of inhaled corticosteroids is also associated with less CAP severity and a lower risk of pneumonia-related mortality," said Jacobo Sellares, MD, PhD, associate faculty member at Hospital Clínic - The August Pi I Sunyer Biomedical Research Institute (IDIBAPS) in Barcelona, Spain. "In our study, prior treatment with inhaled corticosteroids in patients who developed CAP was associated with a lower incidence and less severity of parapneumonic effusion, regardless of the patient's baseline chronic respiratory condition."

The results will be presented at the ATS 2012 International Conference in San Francisco.

The single center study enrolled 3,602 consecutive patients with a diagnosis of CAP. Of these, 659 (18%) had respiratory disorders treated with inhaled corticosteroids before CAP was diagnosed. Respiratory disorders included COPD (56%), asthma (13%), bronchiectasis (6%), and other disorders (25%).

Patients with prior treatment with inhaled corticosteroids, compared with those without, had a significantly lower incidence of parapneumonic effusion (5% vs. 12%). This association remained significant after adjustment for age, sex, comorbidities, and CAP severity. Prior corticosteroid treatment was associated with a higher incidence of simple parapneumonic effusion and a lower incidence of empyema compared with no prior corticosteroid treatment.

Baseline pulmonary disorder did not affect the relationship between corticosteroid treatment and parapneumonic effusion.

"Pleural infection is common in patients with CAP and is associated with an increased mortality risk," said Dr. Sellares. "Our results show that previous treatment of respiratory disorders with inhaled corticosteroids may reduce the risk of developing this dangerous complication."

The potential preventive role of inhaled corticosteroids in preventing parapneumonic effusion in patients with high risk of CAP must be clarified in future randomized studies, according to Dr. Sellares.


"Influence Of Long-Term Use Of Inhaled Corticoids On The Development Of Pleural Effusion In Community Acquired Pneumonia" (Session D14, Wednesday, May 23, 8:15-10:45 a.m., Room 2001-2003, Moscone Convention Center; Abstract 30951)

* Please note that numbers in this release may differ slightly from those in the abstract. Many of these investigations are ongoing; the release represents the most up-to-date data available at press time.

Abstract 30951
Influence Of Long-Term Use Of Inhaled Corticoids On The Development Of Pleural Effusion In Community Acquired Pneumonia
Type: Scientific Abstract
Category: 10.03 - Community Acquired Respiratory Infections (Including Epidemiology) (MTPI)
Authors: J. Sellares1, A. Lopez-Guiraldo1, C. Lucena1, E. Polverino1, C. Cilloniz1, R. Amaro1, M.A. Marcos1, J. Mensa1, A. Torres2; 1Hospital Clinic - Barcelona/ES, 2Hospital Clinic Del Barcelona / - Barcelona/ES

Abstract Body


Long-term use of inhaled corticosteroids (ICS) in patients with Chronic Obstructive Pulmonary Disease (COPD) has been associated with increase risk of CAP. By contrast ICS have been associated with less CAP severity and a decreased risk of pneumonia-related mortality. Pleural infection is a frequent complication of CAP that may increase mortality. The objective of this study was to assess the influence of long-term use of ICS on the incidence and severity of parapneumonic effusion in patients with different baseline respiratory disorders.


We conducted a single centre cohort study of 3602 patients consecutively collected with the diagnosis of CAP. We assessed clinical, radiographic and pleural fluid chemistry and microbiological variables. Pleural effusion was classified according to American College of Chest Physicians guidelines. Patients were classified whether they received prior ICS treatment or not.


659 patients (18%) were treated with ICS before diagnosis of CAP (COPD: 56% Asthma: 13%, Bronchiectasis: 6%, others: 25%). Prior treatment with ICS was significant associated with less incidence of parapneumonic effusion compared to those without prior ICS treatment (5% vs. 12%, p<0.001). The multivariate analysis adjusted by age, sex, comorbidities and CAP severity, showed a significant association between prior ICS treatment and lower incidence of pleural effusion [OR 0.42 (95% CI, 0.28-0.64, p<0.001)]. Prior treatment with ICS was significantly associated with higher incidence of category 1 effusion (<10mm)(53% vs 30%, p=0.008 ) and lower incidence of category 4 (empyiema) compared to those without ICS treatment (3% vs 16%, p=0.05). Prior ICS treatment was associated with higher glucose and lower protein and lactic acid dehydrogenase (LDH) levels in the pleural effusion. No differences were observed in outcomes among the different chronic pulmonary disorders treated with ICS. There was no difference in pneumonia-related 30-d mortality between patients with and those without prior treatment with ICS.


The prior treatment of ICS in patients who develop CAP is associated with lower incidence and less severity of parapneumonic effusion, regardless of the baseline chronic respiratory condition.

Funded by: CibeRes and IDIBAPS

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