Effectiveness of Inhaled Steroids in the Management of Chronic Obstructive Pulmonary Disease
- Charles L. Emerman
- … show all 1 hide
Purchase on Springer.com
$39.95 / €34.95 / £29.95*
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.
Evidence indicates that there is a substantial inflammatory component associated with COPD and that this inflammation is increased during the acute exacerbation. The role of inhaled steroids in COPD has been established through a variety of studies. Inhaled steroids are most effective when given in conjunction with long-acting beta agonists. In those circumstances, patients have an improvement in quality of life, lessening of dyspnea, reduced use of rescue medications, and, in some studies, fewer exacerbations. The side effects associated with inhaled steroid use include an increase in the incidence of pneumonia and cataracts. National recommendations are for the use of inhaled steroids only in conjunction with a long-acting beta agonist.
- Hogg JC, et al. The nature of small-airway obstruction in chronic obstructive pulmonary disease. N Engl J Med. 2004;350(26):2645–53. CrossRef
- Jeffery PK. Structural and inflammatory changes in COPD: a comparison with asthma. Thorax. 1998;53(2):129–36. CrossRef
- • Thomsen MIT, Marott JL, et al. Inflammatory biomarkes and exacerbations in chronic obstructive pulmonary disease. JAMA. 2013;309(22):2353–61. This study outlines the association of inflammation with acute exacerbations of COPD.
- Gizycki MJ, et al. Effects of fluticasone propionate on inflammatory cells in COPD: an ultrastructural examination of endobronchial biopsy tissue. Thorax. 2002;57(9):799–803. CrossRef
- Man SF, et al. The effects of inhaled and oral corticosteroids on serum inflammatory biomarkers in COPD: an exploratory study. Ther Adv Respir Dis. 2009;3(2):73–80. CrossRef
- Boorsma M, et al. Long-term effects of budesonide on inflammatory status in COPD. COPD. 2008;5(2):97–104. CrossRef
- Sin DD, et al. The effects of fluticasone with or without salmeterol on systemic biomarkers of inflammation in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2008;177(11):1207–14. CrossRef
- Perng DW, et al. Inhaled fluticasone and salmeterol suppress eosinophilic airway inflammation in chronic obstructive pulmonary disease: relations with lung function and bronchodilator reversibility. Lung. 2006;184(4):217–22. CrossRef
- Burge PS, et al. Randomised, double blind, placebo controlled study of fluticasone propionate in patients with moderate to severe chronic obstructive pulmonary disease: the ISOLDE trial. BMJ. 2000;320(7245):1297–303. CrossRef
- Calverley PM, et al. One-year treatment with mometasone furoate in chronic obstructive pulmonary disease. Respir Res. 2008;9:73. CrossRef
- John M, et al. Effects of inhaled HFA beclomethasone on pulmonary function and symptoms in patients with chronic obstructive pulmonary disease. Respir Med. 2005;99(11):1418–24. CrossRef
- Jones PW, et al. Disease severity and the effect of fluticasone propionate on chronic obstructive pulmonary disease exacerbations. Eur Respir J. 2003;21(1):68–73. CrossRef
- Macie C, et al. Inhaled corticosteroids and mortality in COPD. Chest. 2006;130(3):640–6. CrossRef
- Soriano JB, et al. A pooled analysis of FEV1 decline in COPD patients randomized to inhaled corticosteroids or placebo. Chest. 2007;131(3):682–9. CrossRef
- •• Yang IA, et al. Inhaled corticosteroids for stable chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2012;7: CD002991. This meta-analysis reviewes 55 studies covering over 16000 patients. The main findings are that inhaled corticosteroids did not consistently effect the rate of decline in pulmonary function. It did decrease the incidence of exacerbation and slowed the rate of decline in quality of life.
- • Vestbo J, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med. 2013;187(4):347–65. This is a recent review of the treatment of stable COPD including recommendations for the use of inhaled corticosteroids.
- • Qaseem A, et al. Diagnosis and management of stable chronic obstructive pulmonary disease: a clinical practice guideline update from the American College of Physicians, American College of Chest Physicians, American Thoracic Society, and European Respiratory Society. Ann Intern Med. 2011;155(3):179–91. This is a collaborative review of the treatment of stable COPD with recommendations on a variety of medications, including inhaled corticosteroids.
- Calverley P, et al. Combined salmeterol and fluticasone in the treatment of chronic obstructive pulmonary disease: a randomised controlled trial. Lancet. 2003;361(9356):449–56. CrossRef
- Mansori F, et al. The effect of inhaled salmeterol, alone and in combination with fluticasone propionate, on management of COPD patients. Clin Respir J. 2010;4(4):241–7. CrossRef
- Dalal AA, et al. COPD-related healthcare utilization and costs after discharge from a hospitalization or emergency department visit on a regimen of fluticasone propionate-salmeterol combination versus other maintenance therapies. Am J Manag Care. 2011;17(3):e55–65.
- Mittmann N, et al. Cost effectiveness of budesonide/formoterol added to tiotropium bromide versus placebo added to tiotropium bromide in patients with chronic obstructive pulmonary disease: Australian, Canadian and Swedish healthcare perspectives. Pharmacoeconomics. 2011;29(5):403–14. CrossRef
- Cazzola M, et al. Onset of action of formoterol/budesonide in single inhaler vs. formoterol in patients with COPD. Pulm Pharmacol Ther. 2004;17(3):121–5. CrossRef
- Calverley PM, et al. Salmeterol and fluticasone propionate and survival in chronic obstructive pulmonary disease. N Engl J Med. 2007;356(8):775–89. CrossRef
- van der Palen J, et al. Cost effectiveness of inhaled steroid withdrawal in outpatients with chronic obstructive pulmonary disease. Thorax. 2006;61(1):29–33. CrossRef
- Wouters EF, et al. Withdrawal of fluticasone propionate from combined salmeterol/fluticasone treatment in patients with COPD causes immediate and sustained disease deterioration: a randomised controlled trial. Thorax. 2005;60(6):480–7. CrossRef
- Nannini LJ, Lasserson TJ, Poole P. Combined corticosteroid and long-acting beta(2)-agonist in one inhaler versus long-acting beta(2)-agonists for chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2012;9:CD006829.
- Ferguson GT, et al. Prevalence and progression of osteoporosis in patients with COPD: results from the towards a revolution in COPD health study. Chest. 2009;136(6):1456–65. CrossRef
- Miller DP, et al. Long-term use of fluticasone propionate/salmeterol fixed-dose combination and incidence of nonvertebral fractures among patients with COPD in the UK General Practice Research Database. Phys Sportsmed. 2010;38(4):19–27. CrossRef
- Almirall J, et al. Inhaled drugs as risk factors for community-acquired pneumonia. Eur Respir J. 2010;36(5):1080–7. CrossRef
- • Calverley PM, et al. Reported pneumonia in patients with COPD: findings from the INSPIRE study. Chest. 2011;139(3):505–12. This study reviews the increase in reported incidence of pneumonia in patients receiving inhaled corticosteroids.
- Crim C, et al. Pneumonia risk in COPD patients receiving inhaled corticosteroids alone or in combination: TORCH study results. Eur Respir J. 2009;34(3):641–7. CrossRef
- O’Byrne PM, et al. Risk of new onset diabetes mellitus in patients with asthma or COPD taking inhaled corticosteroids. Respir Med. 2012;106(11):1487–93. CrossRef
- Faul JL, et al. The effect of an inhaled corticosteroid on glucose control in type 2 diabetes. Clin Med Res. 2009;7(1–2):14–20.
- Weatherall M, et al. Dose-response relationship of inhaled corticosteroids and cataracts: a systematic review and meta-analysis. Respirology. 2009;14(7):983–90. CrossRef
- Effectiveness of Inhaled Steroids in the Management of Chronic Obstructive Pulmonary Disease
Current Emergency and Hospital Medicine Reports
Volume 1, Issue 4 , pp 189-192
- Cover Date
- Online ISSN
- Springer US
- Additional Links
- Inhaled cortico-steroids
- Long-acting beta agonists
- Author Affiliations
- 1. MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA