Inhaled corticosteroids in chronic obstructive pulmonary disease: a review.
BACKGROUND
Chronic obstructive pulmonary disease (COPD) is a disease characterized by chronic airflow obstruction and a progressive lung function decline. Although widely used, the efficacy of inhaled corticosteroids (ICS) in the treatment of COPD remains a matter of debate.


METHODS
This article reviews the evidence about the effects of inhaled corticosteroids in the treatment of COPD.


RESULTS
Short-term treatment with ICS improves lung function and quality of life; in addition, several studies with longer follow-up have shown less decline over time in quality of life, and fewer exacerbations. By contrast, long-term studies have been unable to show substantial improvement in the decline of lung function in COPD. Based on these findings, it was concluded that the use of ICS did not influence the natural course of COPD. However, this conclusion has been challenged by two subsequent studies, TORCH and GLUCOLD, which both showed a reduction in lung-function decline over time with the use of ICS. These two studies indicate that ICS might indeed influence the natural course of the disease, at least in a subgroup of COPD patients.


CONCLUSIONS
Further studies are needed to identify which individuals have a favorable short- and long-term response to ICS treatment.
Telenga
Eef D
ED
University Medical Center Groningen, University of Groningen, Department of Pulmonology PO Box 30.001, 9700 RB Groningen, The Netherlands. e.d.telenga@int.umcg.nl
Kerstjens
Huib A M
HA
Postma
Dirkje S
DS
Ten Hacken
Nick H
NH
van den Berge
Maarten
M
D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D018927:Anti-Asthmatic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D016535:Bronchial Hyperreactivity / Q000175:diagnosis; D001993:Bronchodilator Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D006304:Health Status; D006801:Humans; D011379:Prognosis; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000188:drug therapy*; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D012129:Respiratory Function Tests; D012720:Severity of Illness Index; D012907:Smoking / Q000009:adverse effects; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones; D018927:Anti-Asthmatic Agents; D001993:Bronchodilator Agents