Inhaled Corticosteroids and Chronic Obstructive Pulmonary Disease: Are We Barking Up the Wrong Tracheobronchial Tree?

In many ways, chronic obstructive pulmonary disease (COPD) has already revealed its most terrible truths. Its causes are well recognized, its clinical course has been clearly described, and the means to its prevention are hardly in doubt but difficult to achieve. Despite our familiarity with COPD, it remains among the most common and most fatal diseases in the world. At last count, COPD affected more than 16 million Americans and ranked fourth among the leading causes of death in the United States (1). Still, its persistent mystery is unnerving. Treatment, although unsatisfactory, is expensive in terms of cost as well as human suffering, and the disease has spawned a large industry devoted to the care of its victims. As with many diseases with imperfect therapy, the list of recommended treatments is long, precisely because none of the therapeutic agents is particularly effective in controlling its manifestations or halting its progress.

Because COPD shares the problem of airways obstruction with asthma, many therapies that have been successfully used to treat asthma have also been used to treat COPD. In fact, bronchodilators continue to be the mainstay of symptomatic therapy for COPD whether or not there is evidence …