title: The Pharmacological Treatment of Chronic Obstructive Pulmonary Disease.
abstract: BACKGROUND
  Inhaled corticosteroids (ICS) are markedly less effective against chronic obstructive pulmonary disease (COPD) than against asthma, and also have worse side effects. Whether ICS should be used to treat COPD is currently a matter of debate.
  
  
  METHODS
  This review is based on pertinent articles retrieved by a selective search in PubMed and the Excerpta Medica Database (EMBASE) carried out in May 2015. We analyzed clinical trials of ICS for the treatment of COPD with a duration of at least one year, along with meta-analyses and COPD guidelines.
  
  
  RESULTS
  ICS lower the frequency and severity of COPD exacerbations in comparison to monotherapy with a long-acting ß2-agonist, but have no effect on mortality. Compared to placebo, ICS monotherapy lessens the decline of forced expiratory volume in one second (FEV1) over one year by merely 5.80 mL (statistically insignificant; 95% confidence interval: [-0.28; 11.88]) and only marginally improve quality of life. ICS use in patients with COPD increases the risk of pneumonia. A combination of ICS with a long-acting bronchodilator improves FEV1 by 133 mL [105; 161] and lowers the frequency of severe exacerbations by 39% . The frequency of exacerbations is lowered mainly in patients who have many exacerbations; thus, ICS treatment is suitable only for patients with grade III or IV COPD.
  
  
  CONCLUSIONS
  ICS monotherapy has no clinically useful effect on pulmonary function in COPD. The main form of drug treatment for COPD is with broncho - dilators, either alone or in combination with ICS. ICS can be given to patients with grade III or IV COPD to make exacerbations less frequent. Patients with an asthma-COPD overlap syndrome (ACOS) can benefit from ICS treatment.
authors.affiliation: Department of Pulmonary Medicine, Kassel General Hospital, Fachkrankenhaus Kloster Grafschaft, Schmallenberg, Klinik Schillerhöhe, Stuttgart, Department of Internal Medicine I: Pneumology & Allergology/Immunology, Friedrich Schiller University Jena, Department of Pneumology and Allergy, Medical Clinic III, Bethanien Hospital Moers, Department of Pneumology, University of Leipzig.
authors.forename: Adrian
authors.initials: A
authors.lastname: Gillissen
authors.forename: Peter
authors.initials: P
authors.lastname: Haidl
authors.forename: Martin
authors.initials: M
authors.lastname: Khlhäufl
authors.forename: Klaus
authors.initials: K
authors.lastname: Kroegel
authors.forename: Thomas
authors.initials: T
authors.lastname: Voshaar
authors.forename: Christian
authors.initials: C
authors.lastname: Gessner
mesh_terms: D000280:Administration, Inhalation; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001993:Bronchodilator Agents / Q000008:administration & dosage*; D015897:Comorbidity; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000453:epidemiology* / Q000517:prevention & control; D015995:Prevalence; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy* / Q000453:epidemiology* / Q000523:psychology; D011788:Quality of Life / Q000523:psychology*; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones; D001993:Bronchodilator Agents