Inhaled steroid therapy in chronic obstructive pulmonary disease

Abstract

Chronic obstructive pulmonary disease (COPD) remains difficult to manage. Patients with COPD present with progressive dyspnea; difficulty in stopping smoking; recurrent exacerbations; and, ultimately, respiratory failure. Because of the lack of proven treatments for COPD and because inhaled corticosteroids can prevent airway inflammation and permanent lung damage in patients with asthma, it has become common practice to prescribe inhaled corticosteroids for patients with COPD despite a lack of data suggesting that these agents have any long-term benefit in these patients. In the past 12 months, three randomized, double-blind, placebo-controlled clinical trials (the European Respiratory Society Study on Chronic Obstructive Pulmonary Disease, the Copenhagen City Lung Study, and the Inhaled Steroids in Obstructive Lung Disease study) designed to assess the long-term effect of inhaled corticosteroids in patients with varying severity of airway obstruction have been presented. The results of these studies have been disappointing; they show little to suggest that any long-term benefit is gained from using inhaled corticosteroids in most patients with COPD, whether they continue to smoke or not.

The Role of Interleukin-8 and its Receptors in Inflammatory Lung Disease

“…[67] The best use of corticosteroids in the treatment of COPD remains a subject of much debate. [68] In contrast to in vitro findings, a recent report suggests that in vivo, shortterm corticosteroid treatment does not reduce sputum levels of IL-8 in patients with chronic bronchitis. [69] Further clinical studies on the effects of corticosteroid on IL-8 production in COPD patients would be timely.…”