Thorax 1999;54:7-14 ( January )

Long term effects of inhaled corticosteroids in chronic obstructive pulmonary disease: a meta-analysis

P M van Grunsven,^a C P van Schayck,^a J P Derenne,^d H A M Kerstjens,^e T E J Renkema,^e D S Postma,^e T Similowski,^d R P Akkermans,^a P C M Pasker-de Jong,^b P N R Dekhuijzen,^c C L A van Herwaarden,^c C van Weel^a

^a Department of General Practice and Social Medicine, ^b Department of Epidemiology, ^c Department of Pulmonology, Dekkerswald, ^d University of Nijmegen, The Netherlands Department of Pulmonology, Hospital Pitié-Salpêtrière, Paris, France, ^e Department of Pulmonology, University of Groningen, The Netherlands

Correspondence to: Dr P M van Grunsven, Department of General Practice, University of Nijmegen, P O Box 9101, 6500 HB Nijmegen, The Netherlands.

Received 25 November 1997; Returned to authors 21 January 1998; Revised version received 27 April 1998; Accepted for publication 15 May 1998

BACKGROUNDThe role of inhaled corticosteroids in the long term management of chronic obstructive pulmonary disease (COPD) is still unclear. A meta-analysis of the original data sets of the randomised controlled trials published thus far was therefore performed. The main question was: "Are inhaled corticosteroids able to slow down the decline in lung function (FEV₁) in COPD?"
METHODSA Medline search of papers published between 1983 and 1996 was performed and three studies were selected, two of which were published in full and one in abstract form. Patients with "asthmatic features" were excluded from the original data. Ninety five of the original 140 patients treated with inhaled corticosteroids (81 with 1500 µg beclomethasone daily, six with 1600 µg budesonide daily, and eight with 800 µg beclomethasone daily) and 88 patients treated with placebo (of the initial 144 patients) were included in the analysis. The effect on FEV₁ was assessed by a multiple repeated measurement technique in which points of time in the study and treatment effects (inhaled corticosteroids compared with placebo) were investigated.
RESULTSNo baseline differences were observed (mean age 61 years, mean FEV₁ 45% predicted). The estimated two year difference in prebronchodilator FEV₁ was +0.034 l/year (95% confidence interval (CI) 0.005 to 0.063) in the inhaled corticosteroid group compared with placebo. The postbronchodilator FEV₁ showed a difference of +0.039 l/year (95% CI -0.006 to 0.084). No beneficial effect was observed on the exacerbation rate. Worsening of the disease was the reason for drop out in four patients in the treatment group compared with nine in the placebo group. In the treatment group six of the 95 subjects dropped out because of an adverse effect which may have been related to the treatment compared with two of the 88 patients in the placebo group.
CONCLUSIONSThis meta-analysis in patients with clearly defined moderately severe COPD showed a beneficial course of FEV₁ during two years of treatment with relatively high daily dosages of inhaled corticosteroids.

Keywords: chronic obstructive pulmonary disease; inhaled corticosteroids

---

© 1999 by Thorax
CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

• Lapperre, T. S., Snoeck-Stroband, J. B., Gosman, M. M.E., Jansen, D. F., van Schadewijk, A., Thiadens, H. A., Vonk, J. M., Boezen, H. M., ten Hacken, N. H.T., Sont, J. K., Rabe, K. F., Kerstjens, H. A.M., Hiemstra, P. S., Timens, W., Postma, D. S., Sterk, P. J., the GLUCOLD (Groningen Leiden Universities Cortico, (2009). Effect of Fluticasone With and Without Salmeterol on Pulmonary Outcomes in Chronic Obstructive Pulmonary Disease: A Randomized Trial. ANN INTERN MED 151: 517-527 [Abstract] [Full Text]  
• Gartlehner, G., Hansen, R. A., Carson, S. S., Lohr, K. N. (2006). Efficacy and Safety of Inhaled Corticosteroids in Patients With COPD: A Systematic Review and Meta-Analysis of Health Outcomes. Ann Fam Med 4: 253-262 [Abstract] [Full Text]  
• Simmonds, M. C, Higginsa, J. P T, Stewartb, L. A, Tierneyb, J. F, Clarke, M. J, Thompson, S. G (2005). Meta-analysis of individual patient data from randomized trials: a review of methods used in practice. Clin Trials 2: 209-217 [Abstract]  
• Decramer, M, Gosselink, R, Bartsch, P, Lofdahl, C-G, Vincken, W, Dekhuijzen, R, Vestbo, J, Pauwels, R, Naeije, R, Troosters, T (2005). Effect of treatments on the progression of COPD: report of a workshop held in Leuven, 11-12 March 2004. Thorax 60: 343-349 [Abstract] [Full Text]  
• Albers, M., Schermer, T., van den Boom, G., Akkermans, R., van Schayck, C., van Herwaarden, C., van Weel, C. (2004). Efficacy of Inhaled Steroids in Undiagnosed Subjects at High Risk for COPD: Results of the Detection, Intervention, and Monitoring of COPD and Asthma Program. Chest 126: 1815-1824 [Abstract] [Full Text]  
• Tashkin, D. P., Murray, H. E., Skeans, M., Murray, R. P., for the Lung Health Study Research Group, (2004). Skin Manifestations of Inhaled Corticosteroids in COPD Patients: Results From Lung Health Study II. Chest 126: 1123-1133 [Abstract] [Full Text]  
• Sutherland, E. R. (2003). Inhaled Corticosteroids in Chronic Obstructive Pulmonary Disease. ANN INTERN MED 139: 864-864 [Full Text]  
• Highland, K. B. (2003). Inhaled Corticosteroids in Chronic Obstructive Pulmonary Disease. ANN INTERN MED 139: 864-865 [Full Text]  
• Burge, P S, Lewis, S A (2003). So inhaled steroids slow the rate of decline of FEV1 in patients with COPD after all?. Thorax 58: 911-913 [Full Text]  
• Sutherland, E R, Allmers, H, Ayas, N T, Venn, A J, Martin, R J (2003). Inhaled corticosteroids reduce the progression of airflow limitation in chronic obstructive pulmonary disease: a meta-analysis. Thorax 58: 937-941 [Abstract] [Full Text]  
• Suissa, S. (2003). Effectiveness of Inhaled Corticosteroids in Chronic Obstructive Pulmonary Disease: Immortal Time Bias in Observational Studies. Am. J. Respir. Crit. Care Med. 168: 49-53 [Abstract] [Full Text]  
• Highland, K. B., Strange, C., Heffner, J. E. (2003). Long-Term Effects of Inhaled Corticosteroids on FEV1 in Patients with Chronic Obstructive Pulmonary Disease: A Meta-Analysis. ANN INTERN MED 138: 969-973 [Abstract] [Full Text]  
• Sin, D.D., Man, S.F.P. (2003). Inhaled corticosteroids and survival in chronic obstructive pulmonary disease: does the dose matter?. Eur Respir J 21: 260-266 [Abstract] [Full Text]  
• Gizycki, M J, Hattotuwa, K L, Barnes, N, Jeffery, P K (2002). Effects of fluticasone propionate on inflammatory cells in COPD: an ultrastructural examination of endobronchial biopsy tissue. Thorax 57: 799-803 [Abstract] [Full Text]  
• Verhoeven, G T, Hegmans, J P J J, Mulder, P G H, Bogaard, J M, Hoogsteden, H C, Prins, J-B (2002). Effects of fluticasone propionate in COPD patients with bronchial hyperresponsiveness. Thorax 57: 694-700 [Abstract] [Full Text]  
• Roche, N., Lepage, T., Bourcereau, J., Terrioux, P. (2001). Guidelines versus clinical practice in the treatment of chronic obstructive pulmonary disease. Eur Respir J 18: 903-908 [Abstract] [Full Text]  
• VAN DEN BOOM, G., RUTTEN-VAN MOLKEN, M. P. M. H., MOLEMA, J., TIRIMANNA, P. R. S., VAN WEEL, C., VAN SCHAYCK, C. P. (2001). The Cost Effectiveness of Early Treatment with Fluticasone Propionate 250 {micro}g Twice a Day in Subjects with Obstructive Airway Disease . Results of the DIMCA Program. Am. J. Respir. Crit. Care Med. 164: 2057-2066 [Abstract] [Full Text]  
• FERREIRA, I. M., HAZARI, M. S., GUTIERREZ, C., ZAMEL, N., CHAPMAN, K. R. (2001). Exhaled Nitric Oxide and Hydrogen Peroxide in Patients with Chronic Obstructive Pulmonary Disease . Effects of Inhaled Beclomethasone. Am. J. Respir. Crit. Care Med. 164: 1012-1015 [Abstract] [Full Text]  
• Tattersfield, A E, Harrison, T W (2001). Inhaled steroids for COPD?. Thorax 56: ii2-6 [Full Text]  
• O'BRIEN, A., RUSSO-MAGNO, P., KARKI, A., HIRANNIRAMOL, S., HARDIN, M., KASZUBA, M., SHERMAN, C., ROUNDS, S. (2001). Effects of Withdrawal of Inhaled Steroids in Men with Severe Irreversible Airflow Obstruction. Am. J. Respir. Crit. Care Med. 164: 365-371 [Abstract] [Full Text]  
• Calverley, P.M.A. (2001). Modern treatment of chronic obstructive pulmonary disease. Eur Respir J 18: 60S-66s [Abstract] [Full Text]  
• Lipworth, B. J. (2001). Optimizing Bronchodilator Therapy for COPD. Chest 119: 1628-1630 [Full Text]  
• The Lung Health Study Research Group, (2000). Effect of Inhaled Triamcinolone on the Decline in Pulmonary Function in Chronic Obstructive Pulmonary Disease. NEJM 343: 1902-1909 [Abstract] [Full Text]  
• Nava, S., Compagnoni, M. L. (2000). Controlled Short-term Trial of Fluticasone Propionate in Ventilator-Dependent Patients With COPD. Chest 118: 990-999 [Abstract] [Full Text]  
• Burge, P S, Calverley, P M A, Jones, P W, Spencer, S, Anderson, J A, Maslen, T K (2000). Randomised, double blind, placebo controlled study of fluticasone propionate in patients with moderate to severe chronic obstructive pulmonary disease: the ISOLDE trial. BMJ 320: 1297-1303 [Abstract] [Full Text]  
• CALVERLEY, P. M.A. (2000). Inhaled Corticosteroids Are Beneficial in Chronic Obstructive Pulmonary Disease. Am. J. Respir. Crit. Care Med. 161: 341-342 [Full Text]  
• Rudolf, M. (2000). The Reality of Drug Use in COPD : The European Perspective. Chest 117 : 29S-32S [Abstract] [Full Text]  
• Calverley, P., Bellamy, D. (2000). Issues at the interface between primary and secondary care in the management of common respiratory disease bullet 5: The challenge of providing better care for patients with chronic obstructive pulmonary disease: the poor relation of airways obstruction?. Thorax 55: 78-82 [Full Text]  
• POSTMA, D. S., KERSTJENS, H. A. M. (1999). Are Inhaled Glucocorticosteroids Effective in Chronic Obstructive Pulmonary Disease?. Am. J. Respir. Crit. Care Med. 160: S66-71 [Abstract] [Full Text]  
• Kerstjens, H. A M (1999). Clinical evidence: Stable chronic obstructive pulmonary disease. BMJ 319: 495-500 [Full Text]  
• BURGE;, P S., VAN GRUNSVEN, P M, VAN SCHAYCK, C P (1999). Inhaled corticosteroids in COPD. Thorax 54: 655a-655 [Full Text]  
• BURGE, P S. (1999). EUROSCOP, ISOLDE and the Copenhagen City Lung Study. Thorax 54: 287-288 [Full Text]  
• CALVERLEY, P M A (1999). Re-assessing the evidence about inhaled corticosteroids in chronic obstructive pulmonary disease. Thorax 54: 3-4 [Full Text]