P. John Rees, MD
In patients with stable chronic obstructive pulmonary disease (COPD), what are the harms and benefits of inhaled corticosteroid (ICS) therapy?
Included studies compared an ICS with placebo or other inhaled medications in patients ≥ 40 years of age with stable COPD. Outcomes were all-cause mortality at 1 and 3 years, pneumonia, and fractures.
MEDLINE, EMBASE/Excerpta Medica, Cochrane Central Register of Controlled Trials, CINAHL, Web of Science, and PsycINFO (to Feb 2008); and references were searched for published, double-blind, randomized controlled trials (RCTs) with duration ≥ 6 months. 11 RCTs (14 comparisons, n = 14 426) met the selection criteria. 8 comparisons were placebo-controlled; most other trials compared an ICS plus a long-acting β2-agonist (LABA) with the LABA alone. 7 trials reported concealment of allocation, and all trials had blinding of outcome assessors. Mean study duration was 24 months (range 6 to 40 mo).
ICS therapy did not reduce mortality at any time point (Table). ICS use increased risk for pneumonia but not fracture (Table).
In patients with stable chronic obstructive pulmonary disease, inhaled corticosteroid therapy does not reduce mortality but increases risk for pneumonia.
ICSs vs placebo or other inhaled medications (control) in patients with chronic obstructive pulmonary disease*
*ICSs = inhaled corticosteroids; other abbreviations defined in Glossary. Weighted event rates, RRR, RRI, NNT, NNH, and CI calculated from data in article using a fixed-effect model.
†A random-effect model was used.
Rees PJ. Review: Inhaled corticosteroids do not reduce mortality but increase pneumonia in chronic obstructive pulmonary disease. Ann Intern Med. ;150:JC3–6. doi: 10.7326/0003-4819-150-6-200903170-02006
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Published: Ann Intern Med. 2009;150(6):JC3-6.
Chronic Obstructive Airway Disease, Infectious Disease, Pneumonia, Pulmonary/Critical Care.
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