Oral corticosteroid therapy for patients with stable chronic obstructive pulmonary disease: a meta-analysis

Article Abstract:

Chronic obstructive pulmonary disease is a disease process that results in the decreased ability of the lungs to perform their function of ventilation, the oxygenation of the blood. Symptoms include dyspnea (difficulty breathing); chronic cough; and decreased maximal breathing capacity. Chronic obstructive pulmonary disease may result from chronic bronchitis (inflammation of the lower airways); pulmonary emphysema (distention of lung tissue by the collection of air or gas in the lungs); or chronic asthma. The effectiveness of oral corticosteroid agents in treating patients with chronic obstructive pulmonary disease was assessed. Review of the medical literature produced 33 studies of oral corticosteroid use in chronic obstructive pulmonary disease since 1951. The quality of the studies was assessed by comparing the methodology with consideration of nine criteria developed by physicians and investigators. Response to corticosteroid treatment was defined as a 20 percent increase in the forced expiratory volume at one second (FEV1), a measure of lung function. Ten studies fulfilled the criteria for sufficient study quality. The findings of these studies showed that oral corticosteroid treatment resulted in a 20 percent or more improvement in FEV1, about 10 percent more than observed in patients receiving a placebo. When treating patients with chronic obstructive pulmonary disease, the side effects of corticosteroid agents must be weighed against the relatively modest therapeutic benefit provided by these drugs. (Consumer Summary produced by Reliance Medical Information, Inc.)

Pulmonary function tests

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Long-term effects of inhaled corticosteroids on FEV(sub 1) in patients with chronic obstructive pulmonary disease: a meta-analysis

Article Abstract:

Background: There is no consensus on the effectiveness of inhaled corticosteroids for the treatment of chronic obstructive pulmonary disease (COPD). Purpose: To evaluate the long-term effects of inhaled corticosteroids on the rate of FEV(sub 1) decline in patients with COPD. Data Sources: MEDLINE, EMBASE, CISCOM, and AMED databases and the Cochrane Library (1966 to December 2002), reference lists from identified articles, and consultation with experts. Searches were not limited to the English language. Study Selection: Randomized, placebo-controlled trials that examined the rate of FEV(sub 1) decline as a primary outcome in patients with COPD. Data Extraction: Two reviewers independently extracted the data by using predetermined criteria. Data Synthesis: For the six studies that met the inclusion criteria, the summary estimate for the difference in FEV(sub 1) decline between the placebo and treatment groups was ?5.0 +/- 3.1 mL/y (95% CI, -11.2 to 1.2 mL/y; P=0.11). Conclusions: The use of inhaled corticosteroids was not associated with the rate of FEV(sub 1) decline in 3571 patients followed for 24 to 54 months.

Inhaled medication, Author Abstract

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Inhaled corticosteroids and chronic obstructive pulmonary disease: are we barking up the wrong tracheobronchial tree?

Article Abstract:

Inhaled corticosteroid drugs may improve symptoms in some patients with chronic obstructive pulmonary disease (COPD) but they may not necessarily improve survival. COPD is different from asthma although both diseases cause airway obstruction. Only COPD patients who have eosinophil infiltration in their lungs will benefit from corticosteroid drugs.

Editorial

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