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BRIEF COMMUNICATION

Long-Term Effects of Inhaled Corticosteroids on FEV₁ in Patients with Chronic Obstructive Pulmonary Disease

A Meta-Analysis

Kristin B. Highland, MD; Charlie Strange, MD; and John E. Heffner, MD

17 June 2003 | Volume 138 Issue 12 | Pages 969-973

Background: There is no consensus on the effectiveness of inhaled corticosteroids for the treatment of chronic obstructive pulmonary disease (COPD).

Purpose: To evaluate the long-term effects of inhaled corticosteroids on the rate of FEV₁ decline in patients with COPD.

Data Sources: MEDLINE, EMBASE, CISCOM, and AMED databases and the Cochrane Library (1966 to December 2002), reference lists from identified articles, and consultation with experts. Searches were not limited to the English language.

Study Selection: Randomized, placebo-controlled trials that examined the rate of FEV₁ decline as a primary outcome in patients with COPD.

Data Extraction: Two reviewers independently extracted the data by using predetermined criteria.

Data Synthesis: For the six studies that met the inclusion criteria, the summary estimate for the difference in FEV₁ decline between the placebo and treatment groups was –5.0 ± 3.2 mL/y (95% CI, –11.2 to 1.2 mL/y; P = 0.11).

Conclusions: The use of inhaled corticosteroids was not associated with the rate of FEV₁ decline in 3571 patients followed for 24 to 54 months.

Editors' Notes Context Experts disagree about the benefits and harms of inhaled corticosteroids for patients with chronic obstructive pulmonary disease (COPD). Contribution This meta-analyses of six randomized, controlled trials found no major differences in the rate of FEV1 decline between patients given inhaled steroids or placebo for 2 to 4 years. Trials showed varying results on the effects of steroids on respiratory symptoms, rates of clinical episodes, adrenal function, and bone density. Implications Inhaled steroids probably do not modify long-term decline in lung function in patients with COPD. Trade-offs between other potential clinical benefits and harms remain unclear. –The Editors

 

Author and Article Information

From Medical University of South Carolina, Charleston, South Carolina.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Kristin B. Highland, MD, Division of Pulmonary, Critical Care, Allergy and Clinical Immunology, Medical University of South Carolina, 96 Jonathan Lucas Street, Suite 812 CSB, PO Box 250623, Charleston, SC 29425; e-mail, highlakb{at}musc.edu.

Current Author Addresses: Drs. Highland, Strange, and Heffner: Division of Pulmonary, Critical Care, Allergy and Clinical Immunology, Medical University of South Carolina, 96 Jonathan Lucas Street, 812 CSB, Box 250623, Charleston, SC 29425.

Author Contributions: Conception and design: K.B. Highland.

Analysis and interpretation of the data: K.B. Highland, C. Strange.

Drafting of the article: K.B. Highland, J.E. Heffner.

Critical revision of the article for important intellectual content: C. Strange, J.E. Heffner.

Final approval of the article: K.B. Highland, J.E. Heffner.

Statistical expertise: K.B. Highland.

Administrative, technical, or logistic support: K.B. Highland.

Collection and assembly of the data: K.B. Highland.

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