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Some promising findings on the effects of inhaled corticosteroids on mortality in COPD
Chronic obstructive pulmonary disease (COPD) is arguably the most common chronic disease of the lungs at present and, by 2020, it will be the third leading cause of death worldwide.1 COPD is associated with a relentless decline in forced expiratory volume in 1 second (FEV1) and, in the later stages, the condition progresses to pulmonary hypertension and hypoxic respiratory failure.
Few interventions have been shown to affect the outcome of COPD. The Lung Health Study-1 (LHS-1) showed that smoking cessation decreases the accelerated decline in FEV1 characteristic of this disease2 and, more recently, that smoking cessation is associated with decreases in cardiovascular and lung cancer mortality in patients with COPD.3 Furthermore, two randomised controlled studies of long term oxygen therapy (LTOT) showed that LTOT improves mortality in patients with COPD complicated by hypoxic respiratory failure.4,5
Because so few interventions have been shown to affect mortality and FEV1 decline in COPD, two further outcomes have been studied arising from the observed close association between exacerbation frequency and health related quality of life.6 In the ISOLDE study (Inhaled corticosteroids in Obstructive Lung Disease in Europe), inhaled corticosteroids were shown to slow the decline in health status over time and also to decrease exacerbation frequency.7 Further statistical modelling has shown that the effect of inhaled corticosteroids on quality of life is largely due to their effect on exacerbation frequency.8 Recent studies have closed the loop between exacerbation frequency, mortality, and lung function decline by showing that patients with a history of frequent exacerbations have an accelerated decline in FEV19,10 and increased mortality from COPD.11 From these data one would therefore expect that interventions that reduce …
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