TY - JOUR
T1 - Inhaled corticosteroids in chronic obstructive pulmonary disease
AU - Suissa, Samy
AU - McGhan, Ryan
AU - Niewoehner, Dennis
AU - Make, Barry
N1 - Copyright:
Copyright 2008 Elsevier B.V., All rights reserved.
PY - 2007/10
Y1 - 2007/10
N2 - The effectiveness of inhaled corticosteroids (ICS) in patients with chronic obstructive pulmonary disease (COPD) remains controversial. Randomized controlled trials, meta-analyses, medication withdrawal studies, and observational reports have examined this question, with mixed results. Observational studies have been subject to criticism because of study design involving immortal time bias. Some randomized controlled trials suggest small benefits in lung function and health status, and a reduction in the rate of acute exacerbations of COPD and mortality, but their incomplete follow-up and statistical methods have been criticized. The greatest benefits of ICS in COPD have been reported with use of ICS and long-acting β-agonist combination therapy, although no benefit was found for the primary outcome studied under the most rigorous methodology by the recent TORCH and Optimal randomized trials. Thus, although future randomized trials will need to be conducted with the most rigorous methodology for all outcomes, much uncertainty remains regarding the potential benefits of ICS in COPD.
AB - The effectiveness of inhaled corticosteroids (ICS) in patients with chronic obstructive pulmonary disease (COPD) remains controversial. Randomized controlled trials, meta-analyses, medication withdrawal studies, and observational reports have examined this question, with mixed results. Observational studies have been subject to criticism because of study design involving immortal time bias. Some randomized controlled trials suggest small benefits in lung function and health status, and a reduction in the rate of acute exacerbations of COPD and mortality, but their incomplete follow-up and statistical methods have been criticized. The greatest benefits of ICS in COPD have been reported with use of ICS and long-acting β-agonist combination therapy, although no benefit was found for the primary outcome studied under the most rigorous methodology by the recent TORCH and Optimal randomized trials. Thus, although future randomized trials will need to be conducted with the most rigorous methodology for all outcomes, much uncertainty remains regarding the potential benefits of ICS in COPD.
KW - Beta-agonist bronchodilators
KW - Chronic obstructive pulmonary disease
KW - Inhaled corticosteroids
KW - Quality of life
KW - Survival
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U2 - 10.1513/pats.200701-024FM
DO - 10.1513/pats.200701-024FM
M3 - Review article
C2 - 17878466
AN - SCOPUS:35148813940
SN - 1546-3222
VL - 4
SP - 535
EP - 542
JO - Proceedings of the American Thoracic Society
JF - Proceedings of the American Thoracic Society
IS - 7
ER -