title: Do chronic inhaled steroids alone or in combination with a bronchodilator prolong life in chronic obstructive pulmonary disease patients?
abstract: OBJECTIVE
  Inhaled corticosteroids with or without long-acting beta2 adrenergic agonists are commonly used to treat patients with chronic obstructive pulmonary disease to attenuate symptoms and to prevent exacerbations. Whether these medications prolong survival is uncertain.
  
  
  RESULTS
  Inhaled corticosteroids attenuate airway and systemic inflammation, reduce airway hyperreactivity, improve patient symptoms and prevent exacerbations in chronic obstructive pulmonary disease patients. The data on mortality are mixed. A pooled analysis of published randomized controlled trials indicated that inhaled corticosteroids reduced mortality by around 25%; however other studies have failed to show a beneficial effect on mortality. The addition of long-acting beta2 adrenergic agonists to inhaled corticosteroids enhances the clinical effectiveness of these medications and confers incremental mortality benefits to patients. Interestingly, these medications appear to be especially beneficial in reducing cardiovascular morbidity and mortality, though large randomized controlled trials powered specifically on these endpoints are needed to confirm these early findings.
  
  
  CONCLUSIONS
  Inhaled corticosteroids, especially with long-acting beta2 adrenergic agonists, reduce airway inflammation and appear to prolong survival in chronic obstructive pulmonary disease patients. They may be particularly effective in reducing cardiovascular morbidity and mortality of patients, pending confirmation by additional clinical studies powered specifically on these endpoints.
authors.affiliation: The University of British Columbia (Respiratory Division), Vancouver, British Columbia, Canada. dsin@mrl.ubc.ca
authors.forename: Don D
authors.initials: DD
authors.lastname: Sin
authors.forename: S F Paul
authors.initials: SF
authors.lastname: Man
mesh_terms: D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D000318:Adrenergic beta-Agonists / Q000008:administration & dosage; D000420:Albuterol / Q000008:administration & dosage / Q000031:analogs & derivatives*; D000730:Androstadienes / Q000008:administration & dosage*; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage*; D004338:Drug Combinations; D000068297:Fluticasone-Salmeterol Drug Combination; D006801:Humans; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy* / Q000401:mortality; D016032:Randomized Controlled Trials as Topic; D016019:Survival Analysis
chemical_list: D000305:Adrenal Cortex Hormones; D000318:Adrenergic beta-Agonists; D000730:Androstadienes; D018927:Anti-Asthmatic Agents; D004338:Drug Combinations; D000068297:Fluticasone-Salmeterol Drug Combination; D000420:Albuterol