Steroid Use Does Not Affect COPD Outcome

The findings of a new study seem to indicate that the regular use of inhaled steroids does not improve survival or prevent disease flare-ups in patients with chronic obstructive pulmonary disease (COPD), contrary to some reports. The new study was conducted to address possible bias in previous research.

The findings of a new study indicate that the regular use of inhaled steroids does not improve survival or prevent disease flare-ups in patients with chronic obstructive pulmonary disease (COPD), contrary to some reports. The new study was conducted to address possible bias in previous research. The benefits of inhaled steroids for COPD is a controversial topic, lead author Dr. Vincent S. Fan, from the University of Washington in Seattle, and colleagues note. While some studies have suggested an improvement in survival, others have failed to demonstrate this. Fan’s team suggests this disparity may arise from study bias that can arise if the effects of inhaled corticosteroids are assessed after some of the subjects have died, so that the surviving patients have a greater amount of time to receive these drugs. To avoid this type of study bias, they conducted a study using “time-dependent” methods. Specifically, the authors wanted to determine if using inhaled steroids for at least 80 percent of the time reduced death rates and prevented flare-ups in COPD patients. Of the 8,033 patients included in the study, nearly 2,700 were prescribed an inhaled steroid for at least 80 percent of a three-month interval. There was no evidence that average steroid use at low or high/medium doses reduced the risk of death, the authors note. Similarly, recent steroid use was not associated with a survival benefit. Inhaled steroid use also did not appear to affect hospitalizations or flare-ups due to COPD, the researchers report in the American Journal of Respiratory and Critical Care Medicine. The findings suggest that the previously reported protective effects of inhaled steroids on death may have been influenced by confounding factors, the investigators note. Because other studies have used a decline in lung function as the primary outcome, the current results further support performing a larger trial in which COPD patients are randomly assigned to inhaled corticosteroids or placebo to see if inhaled steroids influence disease survival or flare-ups, they add. (Source: American Journal of Respiratory Critical Care Medicine, December 15, 2003)