In Elderly, Inhaled Steroids May Help Chronic Lung Disease
May 11, 2000 (Toronto) - Elderly people with a debilitating and sometimes deadly respiratory condition known as chronic obstructive pulmonary disease (COPD) are less likely to be hospitalized or to die of their disease if they use inhaled steroids, according to researchers.
COPD causes breathing to be difficult for patients because their airway tissues are less elastic. Their airways may also be chronically inflamed, and inflammation can cause permanent damage known as "airway remodeling." For this reason, physicians often prescribe inhaled corticosteroids, also simply called steroids, to COPD patients. These medications, a mainstay medication for asthma, come in a standard inhaler canister and work by reducing inflammation.
The use of inhaled steroids in COPD patients has been controversial, says lead author, Don D. Sin, MD, because it was uncertain whether patients benefited from taking them. He spoke in Toronto at a meeting of respiratory specialists.
"Earlier studies measured lung function, and did not clearly show that this therapy improved lung function," Sin tells WebMD. "In this study, we studied whether patients had to be hospitalized due to COPD and whether or not they died due to COPD. In other words, how do these patients feel? What is their survival?" He is an assistant professor of medicine at the University of Alberta in Edmonton.
In order to resolve the controversy, Sin and colleagues reviewed the records of all 22,225 patients in Ontario who were older than 65 and who had been hospitalized at least once for COPD between 1992 and 1996. Of these, 52% had received at least one prescription of inhaled steroids within 90 days after they had been discharged from the hospital.
In the year following discharge, the patients who had received inhaled steroids were 25% less likely to be hospitalized again or to die than those who didn't get these medications, says Sin. Further, the worse their disease was, the more effective the inhaled steroids were: Among patients with severe COPD, those on inhaled steroids were 30% less likely to die or to have a subsequent hospitalization. For those with less severe disease, the difference was 19%.