Study: Inhaled Corticosteroids Benefit COPD

The following was originally published at healthcentral.com/copd on June 15, 2015

Study Confirms Benefit of Inhaled Corticosteroids For COPD

While recent studies have shed some doubt about the benefits of using inhaled corticosteroids as a top-line treatment for COPD, a recent review of studies confirms they do, indeed, benefit COPD patients. Inhaled corticosteroids (ICS) are medicines that work to reduce inflammation in COPD lungs; thus, making airways less sensitive to COPD triggers. Common inhalers that deliver inhaled steroids to COPD lungs include Qvar, Advair, Symbicort, and Breo. Pulmicort may be delivered using a nebulizer. While typically considered top-line COPD medicines, various studies have linked inhaled corticosteroids with pneumonia. Other studies show they don’t even reduce COPD flare-ups. So this left many physicians wondering if the benefits were worth the risks.

A new study, however, reported at the 2015 American Thoracic Society Conference in Denver, shines the light back in the other corner, indicating that, yes indeed, ICS do benefit COPD patients. The study was a material analysis study, meaning that results from over 29 randomized trials and observational studies were analyzed.

According to RT Magazine, “ICS for COPD Decrease Mortality Risk for Pneumonia, Other Causes,” six of the randomized trials showed ICS did not increase the risk of pneumonia, and seven of the observational studies actually showed a decrease in the risk of pneumonia.

Overall, the review shows that ICS may still increase the risk for getting pneumonia among the COPD population. At the same time, however (and this is the good news), ICS lowers the risk of COPD patients dying from pneumonia or any other cause.

Basically, even though ICS may increase your risk for acquiring pneumonia, they make your COPD flare-ups less severe; they make your lungs stronger and better capable of dealing with the flare-ups caused by any asthma trigger.

With any medicine used for any disease condition, it’s always important to weigh the benefits against any potential risks. One potential risk of ICS may be the risk of getting pneumonia. A potential benefit is that they may help you live better -- and longer -- with COPD. Speak with your doctor if you are considering these medications.

Further reading:

• ICS for COPD Decrease Mortality Risk for Pneumonia, Other Causes
• Inhaled Corticosteroids in COPD and the risk of serious pneumonia
• Inhaled Steroids Don’t Reduce COPD Exacerbations
• Best COPD Medicine
• Learn about controller medicine

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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