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Thursday, August 21, 2014

Do inhaled corticosteroids reduce COPD exacerbations?

There has been an increase in the number of physicians ordering inhaled corticosteroids for patients suffering with pneumonia and chronic obstructive pulmonary disease.  So, is there any evidence to support this treatment regime.

Let's review the evidence:

1.  Norton JL et al notes that the use of inhaled steroids is among the most common treatment for pneumonia.  However, they also reduce the immune response and, therefore, slightly increase the risk of being diagnosed with pneumonia.

2.  An article in the April 15, 2011, issue of American Thoracic Society's Journal of Respiratory and Clinical Critical Care Medicine, reported on a review of clinical studies, which concluded that inhaled corticosteroids help to reduce mortality compared to those who were not taking inhaled corticosteroids. They concluded inhaled steroids reduce exacerbations by reducing the underlying inflammation in the air passages. However, while it decreases exacerbations, it also increases the risk for catching pneumonia.  Those using inhaled steroids had a 30 day mortality rate of 10%, and those not using it had a 13.6% mortality rate. The 90 day mortality rate was 17.3% for those who used ICS, and 22.8 for those not using ICS.

3.  Ritesh Agarwal et al studied the effects of ICS on COPD patients and concluded: "There is only a modest benefit of ICS in preventing COPD exacerbations, which is not related to the level of baseline lung function on metaregression analysis. The benefits of ICS in preventing COPD exacerbations thus seem to be overstated."

Conclusion:  There does seem to be evidence that inhaled corticosteroids reduce exacerbations of COPD.

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