Am. J. Respir. Crit. Care Med.,
Volume 160, Number 5, November 1999, S66-S71
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S71.Chronic obstructive pulmonary disease (COPD) constitutes an enormous, and growing, health problem, the treatment of which has been less than satisfactory so far. COPD is a chronic inflammatory
process in the airway wall of the large and peripheral airways as well as in the parenchyma. Because
of this inflammation, glucocorticosteroids (steroids) have been investigated in more than 100 studies. By tradition, the forced expiratory volume in 1 s (FEV1) has been utilized as the main outcome
parameter. More recently, exacerbation frequency and health status (quality of life) have been
added as end points. Oral steroids have been demonstrated to be useful during exacerbations, although the effects are smaller than in exacerbations of asthma. In stable COPD, 10% more patients
respond favorably to a 2-wk course of steroids than to placebo. The long-term effects of oral steroids
have not been evaluated in randomized controlled trials. There have now been 10 studies of inhaled
steroids of short duration, defined as up to 3 mo. In general, there was no effect on FEV1. No other
parameters of lung function were consistently measured. Several studies showed a small effect on
some inflammatory parameters, but none of these were comparable between studies and therefore await further confirmation and elaboration. In total, eight studies evaluated inhaled steroids over a
long period, i.e., at least 6 mo. Five of these have been published, and three major large-scale studies
have been presented as abstracts at major meetings but not yet published in full. On the basis of
these studies, there seems to be an effect of inhaled steroids during the first 3-6 mo of use, but
thereafter no effect on the subsequent decline of lung function has been found. Two studies have
documented a reduction in exacerbation frequency and an improvement in health status. In summary, as far as FEV1 is concerned, there is only a short-term benefit of inhaled steroids at best. The
improvements in exacerbations and health status need to be confirmed and valued, but could well
be important to patients. There is an urgent need to identify those patients within the large heterogeneous group of patients with COPD who benefit from steroids. For this, it would be useful to pool
data from the long-term studies. Postma DS, Kerstjens HAM. Are inhaled glucocorticosteroids
effective in chronic obstructive pulmonary disease?
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  D. W. Mapel Treatment Implications on Morbidity and Mortality in COPD Chest, August 1, 2004; 126(2_suppl_1): 150S - 158S. [Abstract] [Full Text] [PDF]
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 D. A. Mahler, P. Wire, D. Horstman, C.-N. Chang, J. Yates, T. Fischer, and T. Shah Effectiveness of Fluticasone Propionate and Salmeterol Combination Delivered via the Diskus Device in the Treatment of Chronic Obstructive Pulmonary Disease Am. J. Respir. Crit. Care Med., October 15, 2002; 166(8): 1084 - 1091. [Abstract] [Full Text] [PDF]
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 R. E. K. Russell, S. V. Culpitt, C. DeMatos, L. Donnelly, M. Smith, J. Wiggins, and P. J. Barnes Release and Activity of Matrix Metalloproteinase-9 and Tissue Inhibitor of Metalloproteinase-1 by Alveolar Macrophages from Patients with Chronic Obstructive Pulmonary Disease Am. J. Respir. Cell Mol. Biol., May 1, 2002; 26(5): 602 - 609. [Abstract] [Full Text] [PDF]
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 P.M.A. Calverley Modern treatment of chronic obstructive pulmonary disease Eur. Respir. J., July 2, 2001; 18(34_suppl): 60S - 66s. [Abstract] [Full Text] [PDF]
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