Data support steroid use in COPD
Scott Camazine/Science Photo Library
COPD: inhaled corticosteroids reduce all-cause and cardiovascular
mortality |
Use of inhaled corticosteroids to treat patients with chronic obstructive pulmonary disease (COPD) reduces risk of death, particularly from cardiovascular causes, according to research published in Chest this month (2006;130:640).
The influence of inhaled corticosteroids on mortality in COPD remains
a controversial issue, say the researchers. Their aim was to determine,
using a health research database, the effect of inhaled corticosteroids
on total and cause-specific mortality in a cohort of COPD patients.
The researchers looked at mortality in 4,022 people 90 to 365 days after
discharge from hospital with a diagnosis of COPD. In people aged 65 years
and over, inhaled corticosteroids were associated with a 25 per cent
reduction in all-cause mortality. A reduction in all-cause mortality
of 53 per cent was seen in people aged 35 to 64 years old. The reduction
appeared to be largely ascribable to reduced cardiovascular mortality
and, to some extent, mortality from COPD, say the researchers. The effect
of corticosteroids was most evident when administered within the first
30 days after discharge, they add.
The authors of an accompanying editorial (ibid, p629) comment that these
data add to the growing body of evidence for the beneficial effects of
inhaled corticosteroids in reducing mortality in COPD patients. “If
true, the ‘effect’ of therapy with inhaled corticosteroids
on cardiovascular mortality in this COPD population would be as large,
if not larger, than that for statins or angiotensin-converting enzyme
inhibitors in the populations of patients with cardiovascular disorders,” they
say. However, they warn that pharmacoepidemiological studies contain
many limitations and biases. They say that more clinical and animal studies
are needed to better understand the mechanisms by which inhaled corticosteroids
may reduce cardiovascular morbidity and mortality in COPD patients. |
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