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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
[+] Article and Author 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@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.


Ann Intern Med. 2003;138(12):969-973. doi:10.7326/0003-4819-138-12-200306170-00008
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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.

Figures

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Figure 1.
Flow diagram of the search and selection processes for trials included in the meta-analysis.

RCT = randomized, controlled trial.

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Figure 2.
Forest plot showing the effect estimate of each study and respective 95% CIs.1P

The size of the box is representative of the weight of the study, which is directly proportional to its precision (that is, inversely proportional to its variance). The pooled estimate for difference in FEV decline between the combined placebo and treatment groups was −5.0 ± 3.2 mL/y (95% CI, −11.2 to 1.2 mL/Y; = 0.11).

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Summary for Patients

Inhaled Steroids for Chronic Obstructive Lung Disease

The summary below is from the full report titled “Long-Term Effects of Inhaled Corticosteroids on FEV1 in Patients with Chronic Obstructive Pulmonary Disease. A Meta-Analysis.” It is in the 17 June 2003 issue of Annals of Internal Medicine (volume 138, pages 969-973). The authors are K.B. Highland, C. Strange, and J.E. Heffner.

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