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Steroid therapy for chronic obstructive pulmonary disease

W Borron1, B P deBoisblanc

  • 1Section of Pulmonary/Critical Care Medicine, Louisiana State University School of Medicine, New Orleans 70112, USA.

Current Opinion in Pulmonary Medicine
|June 5, 1998
PubMed
Summary

Corticosteroids may benefit some patients with chronic obstructive pulmonary disease (COPD), especially those with asthma-like inflammation. Steroid response in COPD is a spectrum, not all-or-nothing, and may be linked to bronchodilator response.

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Area of Science:

  • Pulmonology
  • Respiratory Medicine
  • Pharmacology

Background:

  • Inhaled and oral corticosteroids are beneficial for asthma management.
  • Efficacy of corticosteroids in nonasthmatic, smoking-related chronic obstructive pulmonary disease (COPD) is debated.
  • Previous research suggests a link between beta 2-agonist responsiveness and steroid responsiveness in COPD.

Purpose of the Study:

  • To investigate the efficacy of inhaled and oral corticosteroids in COPD patients.
  • To explore predictors of steroid responsiveness in COPD.
  • To characterize the nature of steroid responsiveness in COPD.

Main Methods:

  • Review of recent data on corticosteroid use in COPD.
  • Analysis of the relationship between bronchodilator response and steroid responsiveness.

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  • Examination of inflammatory markers (sputum eosinophilia) as predictors of steroid response.

    • Main Results:

    • Responsiveness to beta 2-agonists may predict steroid responsiveness in most COPD patients.
    • A poor bronchodilator response does not exclude good steroid responsiveness.
    • COPD patients with asthma-like inflammation (e.g., sputum eosinophilia) are more likely to respond to steroids.
    • Steroid responsiveness in COPD appears to exist on a continuous spectrum, not as an all-or-nothing phenomenon.

    Conclusions:

    • Corticosteroid efficacy in COPD is variable and influenced by inflammatory profiles.
    • Identifying patients with asthma-like characteristics may help predict steroid responsiveness in COPD.
    • Further research is needed to understand the long-term effects of inhaled corticosteroids on COPD progression.