More on Steroids

[larrynz]

Reuters Health

Friday, March 23, 2007


By Anthony J. Brown, MD

NEW YORK (Reuters Health) - Inhaled steroid therapy can improve lung function in people with COPD, but after 6 months the decline in lung function resumes, according to a pooled analysis of trial data.

COPD -- short for chronic obstructive pulmonary disease -- is a progressive lung illness caused by smoking that includes emphysema and chronic bronchitis. It is characterized by difficulty breathing that is not completely reversible.

Inhaled steroids are a mainstay of treatment for COPD patients but whether the medication can actually modify the natural history of COPD is "controversial," lead author Dr. Joan B. Soriano from Recinte Hospital Joan March in Mallorca, Spain, told Reuters Health.

Soriano and colleagues analyzed data from seven controlled trials that compared inhaled steroid therapy with placebo in more than 3,900 COPD patients.

In the first 6 months, inhaled steroid use was associated with a significant average improvement in lung function relative to placebo. The benefit was most pronounced in ex-smokers, rather than current smokers, and in women.

After this initial boost, however, the rate of decline in lung function from 6 to 36 months was not significantly different between patients treated with inhaled steroids and those given placebo.

"Our analysis provides the final answer to the final question" of whether inhaled steroids alter the natural course of COPD, Soriano said. "The answer is no."

Still, the researcher does not believe that this finding will lead to a reduction in the use of inhaled steroids for moderate-to-severe COPD since these agents have been shown to "reduce symptoms and produce meaningful improvements in quality of life."

While inhaled steroids do not slow the decline in FEV1 seen with COPD, Soriano cited three interventions that do: smoking cessation, lung surgery, and oxygen therapy.

SOURCE: Chest, March 2007.