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
"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
The authors compared the results associated with inhaled steroids to those
associated with other medications used to treat COPD, such as inhaled
bronchodilators, known as "rescue inhalers" and the oral medication
theophylline. These other categories of medications were not linked to the
benefits seen with inhaled steroids, says Sin. He also notes that earlier
studies have linked inhaled steroids to fewer flare-ups of COPD symptoms.
Because results were more dramatic in patients with severe COPD, Sin and
colleagues suggested that inhaled steroids be used primarily in patients who
have been hospitalized for their illness. This strategy is in contrast to
asthma therapy, in which inhaled steroids are a first option medication for
"For patients with severe illness, these results suggest that inhaled
steroid therapy may alter the course of disease for these patients," says
Sin. "This type of medication may delay airway remodeling, and it may also
help patients feel better and live longer." Future studies of inhaled
steroids in COPD will likely involve randomized trials with control groups, he
- With chronic obstructive pulmonary disease (COPD), breathing is difficult
because the airway tissues in the lungs are less elastic and may be chronically
- A new study shows that patients with COPD who take inhaled steroids are
less likely to be hospitalized or die from the disease.
- The inhaled medication works by reducing inflammation in the airways and
preventing permanent damage.