title: A pooled analysis of FEV1 decline in COPD patients randomized to inhaled corticosteroids or placebo.
abstract: BACKGROUND
  There is controversy about whether therapy with inhaled corticosteroids (ICSs) modifies the natural history of COPD, characterized by an accelerated decline in FEV(1).
  
  
  METHODS
  The Inhaled Steroids Effect Evaluation in COPD (ISEEC) study is a pooled study of patient-level data from seven long-term randomized controlled trials of ICS vs placebo lasting >/= 12 months in patients with moderate-to-severe COPD. We have previously reported a survival benefit for ICS therapy in COPD patients using ISEEC data. We aimed to determine whether the regular use of ICSs vs placebo improves FEV(1) decline in COPD patients, and whether this relationship is modified by gender and smoking.
  
  
  RESULTS
  There were 3,911 randomized participants (29.2% female) in this analysis. In the first 6 months after randomization, ICS use was associated with a significant mean (+/- SE) relative increase in FEV(1) of 2.42 +/- 0.19% compared with placebo (p < 0.01), which is quantifiable in absolute terms as 42 mL in men and 29 mL in women over 6 months. From 6 to 36 months, there was no significant difference between placebo and ICS therapy in terms of FEV(1) decline (-0.01 +/- 0.09%; p = 0.86). The initial treatment effect was dependent on smoking status and gender. Smokers who continued to smoke had a smaller increase in FEV(1) during the first 6 months than did ex-smokers. Female ex-smokers had a larger increase in FEV(1) with ICS therapy than did male ex-smokers.
  
  
  CONCLUSIONS
  We conclude that in COPD in the first 6 months of treatment, ICS therapy is more effective in ex-smokers than in current smokers with COPD in improving lung function, and women may have a bigger response to ICSs than men. However, it seems that after 6 months, ICS therapy does not modify the decline in FEV(1) among those who completed these randomized clinical trials.
authors.affiliation: Program of Epidemiology and Clinical Research, Fundació Caubet-CIMERA Illes Balears, International Centre for Advanced Respiratory Medicine, Bunyola, Mallorca, Illes Balears, Spain. Electronic address: jbsoriano@caubet-cimera.es.
authors.forename: Joan B
authors.initials: JB
authors.lastname: Soriano
authors.affiliation: James Hogg iCAPTURE Center for Cardiovascular and Pulmonary Research, St. Paul's Hospital, Vancouver, BC, Canada.
authors.forename: Don D
authors.initials: DD
authors.lastname: Sin
authors.affiliation: James Hogg iCAPTURE Center for Cardiovascular and Pulmonary Research, St. Paul's Hospital, Vancouver, BC, Canada.
authors.forename: Xuekui
authors.initials: X
authors.lastname: Zhang
authors.affiliation: James Hogg iCAPTURE Center for Cardiovascular and Pulmonary Research, St. Paul's Hospital, Vancouver, BC, Canada.
authors.forename: Pat G
authors.initials: PG
authors.lastname: Camp
authors.affiliation: Department of Statistics, GlaxoSmihKline R&D, Greenford, Middlesex, UK.
authors.forename: Julie A
authors.initials: JA
authors.lastname: Anderson
authors.affiliation: Department of Medicine, University of Manitoba, Winnipeg, MB, Canada.
authors.forename: Nick R
authors.initials: NR
authors.lastname: Anthonisen
authors.affiliation: Department of Medicine, Oregon Health and Science University, Portland, OR.
authors.forename: A Sonia
authors.initials: AS
authors.lastname: Buist
authors.affiliation: Department of Respiratory Medicine, Heartlands Hospital NHS Trust, Birmingham, UK.
authors.forename: P Sherwood
authors.initials: PS
authors.lastname: Burge
authors.affiliation: Department of Medicine, University Hospital Aintree, Liverpool, UK.
authors.forename: Peter M
authors.initials: PM
authors.lastname: Calverley
authors.affiliation: Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN.
authors.forename: John E
authors.initials: JE
authors.lastname: Connett
authors.affiliation: Department of Statistics, AstraZeneca R&D, Lund, Sweden.
authors.forename: Stefan
authors.initials: S
authors.lastname: Petersson
authors.affiliation: Department of Pulmonology, University of Groningen, the Netherlands.
authors.forename: Dirkje S
authors.initials: DS
authors.lastname: Postma
authors.affiliation: Department of Lung Diseases, Voivodeship Specialist Hospital, Radom, Poland.
authors.forename: Wojciech
authors.initials: W
authors.lastname: Szafranski
authors.affiliation: North West Lung Centre, South Manchester University Hospital NHS Trust, Wythenshawe Hospital, Manchester, UK.
authors.forename: Jørgen
authors.initials: J
authors.lastname: Vestbo
mesh_terms: D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage* / Q000009:adverse effects; D000368:Aged; D002423:Cause of Death; D005260:Female; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume / Q000187:drug effects*; D006801:Humans; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy* / Q000401:mortality; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data*; D012737:Sex Factors; D012907:Smoking / Q000009:adverse effects; D016540:Smoking Cessation; D015996:Survival Rate
chemical_list: D000305:Adrenal Cortex Hormones