COPD is a prevalent disease, with an increasing attributable mortality. Because
inflammation plays a significant role in the pathogenesis of this disease, the use of anti-inflammatory
therapies would appear indicated; hence the widespread use of
corticosteroids in
COPD. Although the majority of patients with stable
COPD do not benefit from systemic
steroids, there is good evidence supporting the use of short courses of systemic
steroids for
COPD exacerbations. With respect to inhaled
corticosteroids, the studies are conflicting. Those patients with an asthmatic component to their disease, or with a positive
bronchodilator test, appear to benefit most from inhaled
steroids. Those with irreversible disease do not benefit from short-term inhaled
steroids. Long-term inhaled
corticosteroids, though not having a significant effect on the rate of decline in spirometric indices, do appear to decrease the number of exacerbations and the rate of decline in health status, reduce respiratory symptoms, decrease use of health care services, and improve airway reactivity. These effects appear more marked in patients with moderate-to-severe disease. Because very few
therapies offer significant benefits to patients with
COPD, and until a test is developed that will distinguish between potential
steroid responders from non-responders, it is worthwhile giving all patients with
COPD a trial (3-6 months) of inhaled
corticosteroids to determine whether they are responsive.