Inhaled Steroids Reduce Mortality in Copd

NEW YORK (Reuters Health) - Inhalation treatment with steroids, which reduce airway inflammation, leads to lower mortality rates from all causes over a 2-year period in patients with chronic obstructive pulmonary disease (COPD), researchers report in the journal Thorax.

"Inhaled steroids have been a controversial therapy in COPD for over a decade," Dr. Donald D. Sin, from St. Paul's Hospital in Vancouver, Canada, told Reuters Health. "They are clearly effective in asthma, a related but different disorder, but some people in the COPD research community felt that the inflammation related to COPD was quite different to that related to asthma" ant the condition would therefor not respond to inhaled steroids.

Analyzing the results of previous studies, Sin and his colleagues tried to provide a definite answer as to whether inhaled steroids did or did not reduce mortality in patients with COPD.

The investigators analyzed pooled data from seven trials that involved 5,085 patients. The effects of inhaled corticosteroids were compared with the effects of a placebo, or "sugar pill," over at least 12 months in patients with stable COPD. "Rather than looking at each individual study...we combined all the seven studies together," Sin explained.

The results showed that those patients assigned to steroids had a reduction in mortality of about 25 percent, compared with those assigned to placebo. "Steroids reduce mortality by that much," Sin said. "It's a big and meaningful difference."

Sin hopes these results will put to rest the controversy about whether COPD patients should be treated with inhaled steroids or not. "They clearly have a beneficial effect on mortality, among other things," he added.

"In terms of research, I think this resurrects the role of anti-inflammatory therapy of COPD. What exact components of the inflammation is responsible or should be modified, that remains to be seen."

Next, the team of investigators will try to understand the fundamental mechanisms that lead to poor outcomes in COPD and find new compounds to modulate the inflammatory pathways, which, according to Sin, are very complex.

SOURCE: Thorax, December 2005.