Do patients with COPD benefit from treatment with inhaled corticosteroids?

In the past few years, treatment with inhaled corticosteroids has become increasingly important in asthma [1, 2]. It appears that inflammation of the airway wall is a major pathophysiological mechanism underlying asthma [3], and perhaps also chronic obstructive pulmonary disease (COPD) [4]. Some long-term studies in asthmatic patients over 1 and 2 yrs have shown that maintenance treatment with inhaled corticosteroids is beneficial [5‐ 7]. In contrast to asthma, the efficacy and therefore the precise role of inhaled corticosteroids is less clear in the treatment of patients with COPD [8, 9]. Corticosteroids are generally given in COPD, in order to treat exacerbations, for a relatively short period of time. The efficacy of long-term treatment with inhaled steroids is not yet established. Whilst in asthma the response is rapid, there are indications that (some) patients with COPD may only respond adequately to (oral) corticosteroids after 6 months to 2 yrs of therapy [10]. We have, therefore, investigated the literature over the past 15 yrs on short-term as well as long-term response to inhaled steroids in COPD. This was done by means of a Medline Search (MeSH headings and/or free text words: antiinflammatory-agents-steroidal; chronic airflow obstruction; COPD-chronic obstructive pulmonary disease). Only randomized controlled studies (English-written) with inhaled steroids were included. Special attention was paid to possible predictors of a long-term response to inhaled steroids in COPD.