[Do we need inhalative steroids in chronic COPD patients?]

The use of inhaled steroids in the management of chronic obstructive pulmonary disease (COPD) is controversially discussed. Neither the optimistic view of the 90s nor the current pessimistic view on these substances seems to be justified. It becomes apparent that a more differentiated approach, depending on the clinical situation and the cellular composition in the airways, is necessary. Patients with severe inflammation, poor lung function, and frequent exacerbations seem to benefit more from inhaled steroids. Patients in early stages of the disease with occasional symptoms only, and patients predominantly suffering from emphysema than from bronchitis seem to have no benefit from this treatment option. Special attention should be turned to mixed types with asthma-like symptoms. The combination of inhaled long-acting beta 2-mimetics and steroids seems to be of advantage; for a final judgment, however, the results of ongoing clinical trials have to be awaited.