Inhaled and Systemic Corticosteroids in Chronic Obstructive Pulmonary Disease

Abstract

Systemic and local inflammation is central to the pathophysiology of chronic obstructive pulmonary disease (COPD). Increased levels of inflammation have been linked to a more progressive course in COPD and have been shown to be present during an exacerbation. Decreases in inflammatory cytokines, C-reactive protein, and inflammatory cells have been observed with corticosteroid use, suggesting a possible mechanism for a therapeutic benefit of steroids. No available data support the routine use of systemic corticosteroids in stable COPD; however, short courses during exacerbations are likely to improve length of hospitalization, lung function, and relapse rate. Inhaled corticosteroids (ICS) decrease the rate of exacerbation and may improve the response to bronchodilators and decrease dyspnea in stable COPD. No study shows that ICS reduce the loss of lung function; however, recent data suggest a possible survival benefit when combined with long-acting b agonists. There are limited data on the use of ICS in the treatment of acute exacerbations of COPD, and its role in this setting must be more clearly defined. The empiric use of systemic corticosteroids perioperatively represents another area of uncertainty. The role of pharmacogenetics in the metabolism of corticosteroids in COPD is evolving but may be partially responsible for the observed variability in patient responsiveness. The potential benefits of systemic or inhaled corticosteroid use must be weighed against the risk of known toxicities.

Randomized, double-blind, placebo-controlled superiority trial of the Yiqigubiao pill for the treatment of patients with chronic obstructive pulmonary disease at a stable stage

“…For example, in previous studies, the reduction in the FEV1 value was 41 ml/year in patients treated with tiotropium, compared with 42 ml/year in a placebo group and 47-69 ml/year in non-treated patients (33,34). Furthermore, the aforementioned therapies result in various side effects such as severe cardiovascular events, osteoporosis and cataracts (9,35,36). Therefore, the development of novel COPD therapies, particularly those able to prevent AE occurrence with minimal side effects, will be crucial for COPD treatment.…”

“…Therefore, COPD therapy should focus on minimizing the risk factors, relieving the symptoms, and preventing AE recurrence (7). However, the current principal therapeutics applied to the treatment of COPD, including the inhalation or administration of hormones, the inhalation of β2 receptor agonists or M receptor antagonists, and home oxygen therapy, are unable to attenuate the progressive lung function loss in patients with COPD, although some of them improved lung function and/or quality of life, particularly in severe COPD (8)(9)(10)(11). In addition, a number of the aforementioned treatments induce side-effects, which may result in adverse drug reactions such as osteoporosis, risks of cardiovascular diseases or cognitive function impairment (12)(13)(14).…”

Co-morbidities of COPD in primary care: frequency, relation to COPD, and treatment consequences

“…Furthermore, the progressive decline in lung function, the identification of co-morbid conditions, and advancing age in elderly patients, typically necessitates the introduction of additional therapies. 1 Table 4 lists the possible drug interactions in patients receiving different types of therapy for COPD; [61][62][63][64][65][66][67][68][69][70][71][72][73][74][75][76] these should be borne in mind, particularly when treating elderly patients with multiple co-morbidities.…”

“…Theophylline should be used with extreme caution in patients with cardiac arhythmias 69 aminophylline Theophylline clearance is reduced in elderly patients (>60 years) and patients with congestive heart failure or cor pulmonale, and increased in elderly smokers 70,76 Oral and inhaled Use of oral and inhaled corticosteroids may be associated with a decrease in bone mineral density and an increased corticosteroids risk of pneumonia Oral corticosteroids may be associated with steroid myopathy, which contributes to muscle weakness, decreased functionality and respiratory failure, and with hyperglycaemia 65,71 The use of oral corticosteroids concomitant with a range of drugs that may be used in comorbid patients (e.g. high-dose aspirin, 68 diuretics, warfarin 67 ) may be associated with drug-drug effects 62 …”

“…63,66 Treatment with ICS, both alone or in combination with LABAs, may increase the likelihood of pneumonia 65,72 Macrolide and…”