The Pharmaceutical Journal
Vol 270 No 7234 p141
1 February 2003

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Long-term survival improved with inhaled corticosteroids in COPD

The long-term survival of patients with chronic obstructive pulmonary disease (COPD) after discharge from hospital is improved by the use of inhaled corticosteroids, say Canadian researchers.

Dr Don Sin, of the University of Alberta, Edmonton, and colleagues studied 6,740 elderly patients with COPD over three years. They found that COPD patients taking inhaled corticosteroids after hospital discharge had a 25 per cent relative reduction in risk for all cause mortality compared with similar patients who did not take these medicines (relative risk 0.75, 95 per cent confidence interval 0.68–0.82).

They also discovered that patients who were taking moderate or high doses of inhaled steroids had a better survival rate than those who were on low-dose corticosteroid therapy.

For pulmonary-specific causes of mortality, inhaled corticosteroid therapy was associated with a 30 per cent risk reduction (0.70, 0.53–0.93).

To test the robustness of the observed relationship between inhaled corticosteroid therapy and mortality, the researchers conducted a series of subgroup analyses.

They found that even among the healthiest members of the cohort inhaled corticosteroids were associated with a survival advantage.

The researchers say: "These data suggest an important role of inhaled corticosteroid therapy in improving clinical outcomes in these high-risk COPD patients." They also suggest that clinicians should consider using doses of inhaled corticosteroids equivalent to 500µg beclometasone or higher daily to achieve maximum survival benefits.

The study is published in the February issue of the European Respiratory Journal (2003;21:260).