Role of inhaled glucocorticoid therapy in stable COPD
- James K Stoller, MD, MS
James K Stoller, MD, MS
- Section Editor — Chronic Obstructive Pulmonary Disease
- Jean Wall Bennett Professor of Medicine, Samson Global Leadership Academy Endowed Chair
- Cleveland Clinic Lerner College of Medicine
- Chairman, Education Institute, Cleveland Clinic
Chronic obstructive pulmonary disease (COPD) is an inflammatory disorder that is characterized by both airway and systemic inflammation . Inhaled glucocorticoid (also called inhaled corticosteroid or ICS) therapy appears to reduce this inflammation [2-6]. Thus, it has been hypothesized that ICS therapy may also improve clinical outcomes.
Clinical evidence that ICS therapy is beneficial to patients with COPD is limited. Despite this, 40 to 50 percent of patients with COPD receive ICS therapy [7,8]. The likely reason for the widespread use of ICS therapy is the clinician's recognition that COPD can have an asthmatic component and the desire to offer the patient maximal therapy.
In this topic review, the beneficial and adverse effects of ICS therapy in patients with COPD are discussed. An approach to ICS therapy is also described. Discussions about the management of stable COPD and the role of systemic glucocorticoids in COPD exacerbations are presented separately. (See "Management of stable chronic obstructive pulmonary disease" and "Management of exacerbations of chronic obstructive pulmonary disease".)
A number of studies have examined the impact of inhaled glucocorticoids (ICS) on lung function, respiratory symptoms, exacerbations, mortality, lung cancer, and airway inflammation. These studies have reported conflicting data for several different outcomes. However, taken together, the data suggest that ICS therapy decreases exacerbations and modestly slows the progression of respiratory symptoms, but has minimal or no impact on lung function and mortality.
Lung function — The impact of ICS therapy on disease progression, as measured by the annual rate of decline of forced expiratory volume in one second (FEV1), has been examined in several randomized trials and three meta-analyses [9-16]. The largest randomized trial  and a meta-analysis found that ICS therapy slightly slowed the decline in lung function, whereas several other studies and a different meta-analysis found no beneficial effect on lung function. As examples:
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