Long term eVects of inhaled corticosteroids in chronic obstructive pulmonary disease: a

Background—The role of inhaled corticosteroids in the long term management of chronic obstructive pulmonary disease (COPD) is still unclear. A meta-analysis of the original data sets of the randomised controlled trials published thus far was therefore performed. The main question was: “Are inhaled corticosteroids able to slow down the decline in lung function (FEV1) in COPD?” Methods—A Medline search of papers published between 1983 and 1996 was performed and three studies were selected, two of which were published in full and one in abstract form. Patients with “asthmatic features” were excluded from the original data. Ninety five of the original 140 patients treated with inhaled corticosteroids (81 with 1500 µg beclomethasone daily, six with 1600 µg budesonide daily, and eight with 800 µg beclomethasone daily) and 88 patients treated with placebo (of the initial 144 patients) were included in the analysis. The eVect on FEV1 was assessed by a multiple repeated measurement technique in which points of time in the study and treatment eVects (inhaled corticosteroids compared with placebo) were investigated. Results—No baseline diVerences were observed (mean age 61 years, mean FEV1 45% predicted). The estimated two year diVerence in prebronchodilator FEV1 was +0.034 l/year (95% confidence interval (CI) 0.005 to 0.063) in the inhaled corticosteroid group compared with placebo. The postbronchodilator FEV1 showed a diVerence of +0.039 l/year (95% CI ‐0.006 to 0.084). No beneficial eVect was observed on the exacerbation rate. Worsening of the disease was the reason for drop out in four patients in the treatment group compared with nine in the placebo group. In the treatment group six of the 95 subjects dropped out because of an adverse eVect which may have been related to the treatment compared with two of the 88 patients in the placebo group. Conclusions—This meta-analysis in patients with clearly defined moderately severe COPD showed a beneficial course of FEV1 during two years of treatment with relatively high daily dosages of inhaled corticosteroids. (Thorax 1999;54:7‐14)

[1]  D. Postma,et al.  Effects of long-term treatment with corticosteroids in COPD. , 1996, Chest.

[2]  J C Yernault,et al.  Optimal assessment and management of chronic obstructive pulmonary disease (COPD). The European Respiratory Society Task Force. , 1995, The European respiratory journal.

[3]  H. Kerstjens,et al.  Costs and effects of inhaled corticosteroids and bronchodilators in asthma and chronic obstructive pulmonary disease. , 1995, American journal of respiratory and critical care medicine.

[4]  W. Bailey,et al.  Effects of Smoking Intervention and the Use of an Inhaled Anticholinergic Bronchodilator on the Rate of Decline of FEV1 , 1994 .

[5]  J. Bousquet,et al.  Eosinophilic and neutrophilic inflammation in asthma, chronic bronchitis, and chronic obstructive pulmonary disease. , 1993, The Journal of allergy and clinical immunology.

[6]  D. Postma,et al.  AIRWAYS HYPERRESPONSIVENESS, BRONCHODILATOR RESPONSE, ALLERGY AND SMOKING PREDICT IMPROVEMENT IN FEV(1) DURING LONG-TERM INHALED CORTICOSTEROID TREATMENT , 1993 .

[7]  C. van Weel,et al.  Slowing the Deterioration of Asthma and Chronic Obstructive Pulmonary Disease Observed during Bronchodilator Therapy by Adding Inhaled Corticosteroids: A 4-Year Prospective Study , 1993, Annals of Internal Medicine.

[8]  J E Cotes,et al.  Lung volumes and forced ventilatory flows , 1993, European Respiratory Journal.

[9]  D. Postma,et al.  A comparison of bronchodilator therapy with or without inhaled corticosteroid therapy for obstructive airways disease. Dutch Chronic Non-Specific Lung Disease Study Group. , 1992, The New England journal of medicine.

[10]  D. Geddes.  Inhaled corticosteroids: benefits and risks. , 1992, Thorax.

[11]  N. Pride,et al.  Failure of inhaled corticosteroids to modify bronchoconstrictor or bronchodilator responsiveness in middle-aged smokers with mild airflow obstruction. , 1992, Chest.

[12]  D. Postma,et al.  Moderately severe chronic airflow obstruction. Can corticosteroids slow down obstruction? , 1988, The European respiratory journal.

[13]  D. Postma,et al.  Severe chronic airflow obstruction: can corticosteroids slow down progression? , 1985, European journal of respiratory diseases.