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Study: Steroids for COPD Don't Extend Life
TUESDAY, Dec. 23 (HealthDayNews) -- In the latest twist in the debate over the best treatments for emphysema and chronic bronchitis, an extensive study suggests a popular type of inhaler doesn't do a thing to help patients live longer. The findings are bad news for doctors who regularly prescribe so-called corticosteroid inhalers, which come under a number of brand names. "This supports the belief that there's a subset of patients in whom these [drugs] are helpful, but in the vast majority they're not," says Dr. Tom Stibolt, a lung specialist with Kaiser Permanente in Portland, Ore. An estimated 16 million Americans, mostly elderly, suffer from emphysema or chronic bronchitis, known in the medical world as chronic obstructive pulmonary disease (COPD). The ailments are the fourth most common cause of death in the United States, making them deadlier than accidents, diabetes, Alzheimer's disease and AIDS. Most of the patients are current or former smokers whose airways narrow after years of smoking, preventing them from breathing properly. Corticosteroids calm the immune system and prevent inflammation in the lungs. In recent years, the drugs have become "first-line" treatments for asthma, and doctors have wondered if they might be just as useful for emphysema and chronic bronchitis patients, says study co-author Dr. Vincent S. Fan, an investigator with the Veterans Affairs Puget Sound Health Care System's division of Health Services Research and Development. Brand names of common corticosteroids include Pulmicort, Flovent, AeroBid and Azmacort. Fan and colleagues examined the medical records of about 8,000 patients with lung disease, of whom 2,654 took corticosteroids for at least 80 percent of a 90-day period. They report their findings in the December issue of the American Journal of Respiratory and Critical Care Medicine. "There was no difference in mortality between the two groups in our study," Fan said. "The conclusion we drew was that inhaled corticosteroids did not improve mortality or decrease hospitalization." However, he notes the study didn't look at whether the inhalers made patients feel better or relieved symptoms. Previous research has suggested corticosteroid inhalers do indeed boost life spans, but Fan says those studies may have been flawed. The researchers also looked at inhalers known as bronchodilators, which are sold under brand names such as Proventil and Ventolin. While these drugs help expand the airways of the lungs, they didn't seem to help patients live longer, either. "None of them prevented death, which wasn't surprising," Fan says. "With most medications for [the lung diseases], the goal is really to improve symptoms and quality of life. They have not been shown to alter mortality." For the most advanced cases of the diseases, the best treatment remains oxygen, Fan says. Doctors are also examining surgical treatments. And, of course, patients should quit smoking. Stibolt, the Oregon doctor, says he thinks too many doctors prescribe corticosteroid inhalers to COPD patients. But he cautions that they may actually do good in some cases. Patients should pay attention to whether they feel worse or the same when they stop using the drugs, he says. "My guess has always been that there's a group of patients, maybe 15 to 20 percent, in whom these drugs are very useful." More information Get details about inhaled corticosteroids from the National Jewish Medical and Research Center. The National Lung Health Education Program has a page explaining COPD. Meanwhile, learn about the top 10 causes of death in the United States here.
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