title: Inhaled corticosteroids in COPD: the clinical evidence.
abstract: In this article, we focus on the scientific evidence from randomised trials supporting treatment with inhaled corticosteroids (ICS) in chronic obstructive pulmonary disease (COPD), including treatment with combinations of long-acting β-agonist (LABA) bronchodilators and ICS. Our emphasis is on the methodological strengths and limitations that guide the conclusions that may be drawn. The evidence of benefit of ICS and, therefore, of the LABA/ICS combinations in COPD is limited by major methodological problems. From the data reviewed herein, we conclude that there is no survival benefit independent of the effect of long-acting bronchodilation and no effect on FEV1 decline, and that the possible benefit on reducing severe exacerbations is unclear. Our interpretation of the data is that there are substantial adverse effects from the use of ICS in patients with COPD, most notably severe pneumonia resulting in excess deaths. Currently, the most reliable predictor of response to ICS in COPD is the presence of eosinophilic inflammation in the sputum. There is an urgent need for better markers of benefit and risk that can be tested in randomised trials for use in routine specialist practice. Given the overall safety and effectiveness of long-acting bronchodilators in subjects without an asthma component to their COPD, we believe use of such agents without an associated ICS should be favoured.
authors.affiliation: Dept of Medicine, Pulmonary Division, Jewish General Hospital, Montreal, Canada Centre for Clinical Epidemiology, Lady Davis Research Institute, Jewish General Hospital, Montreal, Canada pierre.ernst@mcgill.ca.
authors.forename: Pierre
authors.initials: P
authors.lastname: Ernst
authors.affiliation: Dept of Medicine, Pulmonary Division, Jewish General Hospital, Montreal, Canada.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Saad
authors.affiliation: Centre for Clinical Epidemiology, Lady Davis Research Institute, Jewish General Hospital, Montreal, Canada Dept of Epidemiology and Biostatistics, McGill University, Montréal, Canada.
authors.forename: Samy
authors.initials: S
authors.lastname: Suissa
mesh_terms: D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000627:therapeutic use*; D058666:Adrenergic beta-2 Receptor Agonists / Q000008:administration & dosage / Q000627:therapeutic use*; D001993:Bronchodilator Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D004804:Eosinophils / Q000187:drug effects; D005541:Forced Expiratory Volume; D006801:Humans; D007249:Inflammation; D010641:Phenotype; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic; D012107:Research Design; D013183:Sputum; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D058666:Adrenergic beta-2 Receptor Agonists; D001993:Bronchodilator Agents