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Immunosuppressive and Anti-Inflammatory Consequences of ICS Therapy in COPD: The Epidemiology Perspective

Yawn BP, Yawn RA.

Respiratory Drug Delivery 2014. Volume 1, 2014: 25-38.

Abstract:

Inhaled corticosteroids (ICS) are recommended by current guidelines for the management of severe and very severe chronic obstructive pulmonary disease (COPD) or COPD associated with two or more exacerbations per year. ICS have been shown in several studies to decrease rates of exacerbations, especially when combined with long acting bronchodilators, as well as to improve health-related quality of life. However, ICS use is also associated with increased risks of harms such as pneumonia, requiring hospitalization or resulting in death, as well as other harms such as increased risk of fractures, cataracts and bothersome skin and oral problems. At the population level it is not clear that benefits outweigh harms. The most recent research suggests that a combination therapy with the two classes of long acting bronchodilators gains no additional benefit from the addition of ICS at the population level. Further work is required to confirm this finding and to determine if there are any phenotypic or genotypic groups of COPD patients in whom ICS provide greater benefits.