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Citation
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HERO ID
2838858
Reference Type
Journal Article
Title
Inhaled corticosteroids in COPD: the clinical evidence
Author(s)
Ernst, P; Saad, N; Suissa, S
Year
2015
Is Peer Reviewed?
Yes
Journal
European Respiratory Journal
ISSN:
0903-1936
EISSN:
1399-3003
Volume
45
Issue
2
Page Numbers
525-537
PMID
25537556
DOI
10.1183/09031936.00128914
Web of Science Id
WOS:000349509700029
Abstract
In this article, we focus on the scientific evidence from randomised trials supporting treatment with inhaled corticosteroids (ICS) in chronic obstructive pulmonary disease (COPD), including treatment with combinations of long-acting beta-agonist (LABA) bronchodilators and ICS. Our emphasis is on the methodological strengths and limitations that guide the conclusions that may be drawn.
The evidence of benefit of ICS and, therefore, of the LABA/ICS combinations in COPD is limited by major methodological problems. From the data reviewed herein, we conclude that there is no survival benefit independent of the effect of long-acting bronchodilation and no effect on FEV1 decline, and that the possible benefit on reducing severe exacerbations is unclear. Our interpretation of the data is that there are substantial adverse effects from the use of ICS in patients with COPD, most notably severe pneumonia resulting in excess deaths.
Currently, the most reliable predictor of response to ICS in COPD is the presence of eosinophilic inflammation in the sputum. There is an urgent need for better markers of benefit and risk that can be tested in randomised trials for use in routine specialist practice. Given the overall safety and effectiveness of long-acting bronchodilators in subjects without an asthma component to their COPD, we believe use of such agents without an associated ICS should be favoured.
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