Comparing Pneumonia Risks of Budesonide with Fluticasone Among Patients with Asthma in Hong Kong: A Territory-Wide Retrospective Study

Interclass difference in pneumonia risks between budesonide (BUD) and fluticasone were not well studied in asthma. A territory-wide retrospective cohort study was conducted in Hong Kong among adult patients with Global Initiative for Asthma (GINA) step 3 to 5 asthma to examine pneumonia risks among those prescribed BUD or fluticacone (fluticasone furoate (FF) or fluticasone propionate (FP)). There were 16,170 patients included with 7169 (44.3%), 7853 (48.6%), and 1148 (7.1%) of them prescribed BUD, FP, and FF, respectively. Using BUD as the reference group, the adjusted odds ratio (aOR), adjusted incidence rate ratio (aIRR), and adjusted hazard ratio (aHR) for all pneumonia events were 0.95 (0.85–1.06, p = 0.32), 1.05 (95% CI 0.99–1.12, p = 0.14), and 0.94 (95% CI 0.86–1.04, p = 0.23) for fluticasone (FF/FP), respectively. The aOR, aIRR, and aHR for hospitalized pneumonia were 0.95 (95% CI 0.84–1.07, p = 0.39), 1.15 (95% CI 0.63–2.08, p = 0.65), and 1.03 (95% CI 0.96–1.16, p = 0.39) for fluticasone (FF/FP). The aOR, aIRR, and aHR for pneumonia requiring ICU admissions were 1.08 (95% CI 0.58–2.00, p = 0.50), 1.15 (95% CI 0.63–2.08, p = 0.65), and 1.06 (95% CI 0.57–1.97 p = 0.85) for fluticasone (FF/FP), respectively. No significant difference in pneumonia risks for BUD and fluticasone (FF/FP) were observed. There was no significant difference in pneumonia risks for BUD and fluticasone (FF/FP) among patients with moderate to severe asthma. This study looked at whether different inhaled steroids, specifically budesonide and fluticasone (including fluticasone furoate and fluticasone propionate), affect the risk of developing pneumonia in people with asthma. The researchers used medical records from all over Hong Kong to compare the pneumonia risk among patients using these medications. We found that, in patients with moderate to severe asthma, there was no significant difference in the chances of getting pneumonia between those taking budesonide and those taking fluticasone. This means that, unlike in chronic obstructive pulmonary disease, where differences between these drugs have been noted, such differences do not seem to exist for patients with asthma.