Discordant diagnostic criteria for pneumonia in COPD trials: a review

Robert A. Wise, Mona Bafadhel, Courtney Crim, Gerard J. Criner, Nicola C. Day, David M.G. Halpin, Mei Lan K. Han, Peter Lange, David A. Lipson, Fernando J. Martinez, Diego J. Maselli, Dawn Midwinter, Dave Singh, Maeva Zysman, Mark T. Dransfield, Richard E.K. Russell

7 Citations (Scopus)


Inhaled corticosteroids (ICS) have a class effect of increasing pneumonia risk in patients with COPD. However, pneumonia incidence varies widely across clinical trials of ICS use in COPD. This review clarifies methodological differences in defining and recording pneumonia events in these trials and discusses factors that could contribute to the varying pneumonia incidence. Literature searches and screening yielded 40 relevant references for inclusion. Methods used to capture pneumonia events in these studies included investigator-reported pneumonia adverse events, standardised list of signs or symptoms, radiographic confirmation of suspected cases and/or confirmation by an independent clinical end-point committee. In general, more stringent pneumonia diagnosis criteria led to lower reported pneumonia incidence rates. In addition, studies varied in design and population characteristics, including exacerbation history and lung function, factors that probably contribute to the varying pneumonia incidence. As such, cross-trial comparisons are problematic. A minimal set of standardised criteria for diagnosis and reporting of pneumonia should be used in COPD studies, as well as reporting of patients' pneumonia history at baseline, to allow comparison of pneumonia rates between trials. Currently, within-trial comparison of ICS-containing versus non-ICS-containing treatments is the appropriate method to assess the influence of ICS on pneumonia incidence.

Original languageEnglish
Article number210124
JournalEuropean respiratory review : an official journal of the European Respiratory Society
Issue number162
Publication statusPublished - 31 Dec 2021


  • Administration, Inhalation
  • Adrenal Cortex Hormones/adverse effects
  • Humans
  • Pneumonia/diagnosis
  • Pulmonary Disease, Chronic Obstructive/diagnosis


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