Interclass difference in pneumonia risk in COPD patients initiating fixed dose inhaled treatment containing extrafine particle beclometasone versus fine particle fluticasone

David Price* (Corresponding Author), William Henley, José Eduardo Delfini Cançado, Leonardo M Fabbri, Huib AM Kerstjens, Alberto Papi, Nicolas Roche, Elif Şen, Dave Singh, Claus Vogelmeier, Sara Barille, Elena Nudo, Victoria Carter, Derek Skinner, Rebecca Vella, George Georges

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

4 Citations (Scopus)
12 Downloads (Pure)


Background: Inhaled corticosteroids (ICS) afford therapeutic benefits in some COPD patients, but their widespread use is cautioned due to an increased risk of developing pneumonia. Subclass variations exist, and the risk profile differs for individual ICS. Formulation particle size has been identified as a potential effect modifier. The present study compared the risk of pneumonia among new COPD users of fixed-dose combination inhalers containing fine-particle fluticasone (fp-FDC-F) versus extrafine particle beclometasone (ef-FDC-BDP).

Methods: A propensity matched historical cohort study was conducted using data from the Optimum Patient Care Research Database. COPD patients aged ≥40 years with ≥1 year of continuous medical data who initiated fp-FDC-F or ef-FDC-BDP were compared. The primary outcome was time to pneumonia event, as treated, using either sensitive (physician diagnosed) or specific (physician diagnosed and x-ray or hospital admission confirmed) definitions.
Results: A total of 13,316 patients were matched. Initiation of fp-FDC-F (mean dosage furoate 99 µg; propionate 710 µg) was associated with an increased risk of pneumonia versus ef-FDC-BDP (mean beclometasone dose 395 µg), irrespective of definition (sensitive HR 1.38 95%CI 1.14-1.68; specific HR 1.31 95%CI 1.05-1.62).

Conclusions: In the current investigation, we found that in comparison to extrafine beclomethasone, commencing a formulation containing fluticasone is associated with an increased risk of developing pneumonia. These observations support the idea not all ICS are equal in their adverse effects and subclass variations exist and should be carefully considered in the treatment choice.
Original languageEnglish
Pages (from-to)355—370
Number of pages16
JournalInternational journal of chronic obstructive pulmonary disease
Issue number17
Early online date15 Feb 2022
Publication statusPublished - 15 Feb 2022

Bibliographical note

Professor Dave Singh is supported by the National Institute for Health Research (NIHR) Manchester Biomedical Research Centre (BRC). Jaco Vooriham is acknowledged for his contribution to protocol development. We would also like to acknowledge Ms. Shilpa Suresh (MSc) of the Observational and Pragmatic Research Institute (OPRI), Singapore, for editorial and formatting assistance which supported the development of this publication.


  • Inhaled corticosteroids
  • pneumonia
  • COPD
  • Extrafine beclometasone
  • fluticasone


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