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Steroid therapy in chronic obstructive pulmonary disease
Aidan OBrien1, Nicholas S Ward
1Division of Pulmonary and Critical Care Medicine, Providence VA Medical Center, 830 Chalkstone Avenue, Providence, RI 02908, USA. Aidan_O'Brien@Brown.edu
Medicine and Health, Rhode Island
|March 8, 2002
Summary
Inhaled corticosteroids may benefit patients with chronic obstructive pulmonary disease (COPD) by reducing exacerbations and improving health status. A 3-6 month trial is recommended to identify responsive individuals.
Area of Science:
- Pulmonology
- Pharmacology
Background:
- Chronic obstructive pulmonary disease (COPD) is a major cause of mortality, with inflammation playing a key role in its pathogenesis.
- Corticosteroids are widely used for COPD, but their efficacy varies depending on the formulation and patient subgroup.
Purpose of the Study:
- To evaluate the role and efficacy of inhaled corticosteroids (ICS) in managing chronic obstructive pulmonary disease (COPD).
Main Methods:
- Review of existing studies on the use of systemic and inhaled corticosteroids in COPD patients.
- Analysis of patient subgroups who may benefit from inhaled corticosteroids, including those with an asthmatic component or positive bronchodilator test.
Main Results:
- Short courses of systemic steroids are beneficial for COPD exacerbations.
- Inhaled corticosteroids show conflicting results; benefit is most apparent in patients with an asthmatic component or positive bronchodilator test.
- Long-term ICS do not significantly impact spirometric decline but reduce exacerbations, improve health status, respiratory symptoms, healthcare utilization, and airway reactivity, particularly in moderate-to-severe COPD.
Conclusions:
- A trial of inhaled corticosteroids for 3-6 months is worthwhile for all COPD patients to determine individual responsiveness, given the limited therapeutic options.
- Identifying steroid responders versus non-responders remains a challenge, necessitating empirical trials.