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%.
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 many patients.
"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 says.
- With chronic obstructive pulmonary disease (COPD), breathing is difficult because the airway tissues in the lungs are less elastic and may be chronically inflamed.
- 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.