Steroid therapy in chronic obstructive pulmonary disease

COPD is a prevalent disease, with an increasing attributable mortality. Because inflammation plays a significant role in the pathogenesis of this disease, the use of anti-inflammatory therapies would appear indicated; hence the widespread use of corticosteroids in COPD. Although the majority of patients with stable COPD do not benefit from systemic steroids, there is good evidence supporting the use of short courses of systemic steroids for COPD exacerbations. With respect to inhaled corticosteroids, the studies are conflicting. Those patients with an asthmatic component to their disease, or with a positive bronchodilator test, appear to benefit most from inhaled steroids. Those with irreversible disease do not benefit from short-term inhaled steroids. Long-term inhaled corticosteroids, though not having a significant effect on the rate of decline in spirometric indices, do appear to decrease the number of exacerbations and the rate of decline in health status, reduce respiratory symptoms, decrease use of health care services, and improve airway reactivity. These effects appear more marked in patients with moderate-to-severe disease. Because very few therapies offer significant benefits to patients with COPD, and until a test is developed that will distinguish between potential steroid responders from non-responders, it is worthwhile giving all patients with COPD a trial (3-6 months) of inhaled corticosteroids to determine whether they are responsive.