Systematic review updates evidence for inhaled corticosteroids in stable COPD

By Melanie Hinze

The potential benefits of inhaled corticosteroids (ICS) for chronic obstructive pulmonary disease (COPD) should be weighed against possible adverse effects, according to a recently published article in the Cochrane Database of Systematic Reviews.

The Australian authors reviewed data from 36 primary studies including 23,139 participants (mean age range 52 to 67 years) with stable COPD. Their aim was to update the evidence on the use of ICS as long-term monotherapy versus placebo for stable COPD.

They found that long-term use of ICS monotherapy, defined as more than six months, was likely to reduce the rate of COPD exacerbations. It also probably slowed the rate of decline in both quality of life and lung function.

However, they found that mortality was not affected when ICS was used as a monotherapy in trials, and the rate of adverse events, including pneumonia, oropharyngeal candidiasis and hoarseness, increased.

The authors concluded that although ICS were no longer recommended as monotherapy, given the probable benefits of ICS highlighted in their review they should continue to be considered for use in combination with long-acting bronchodilators (such as in single inhaler triple therapy) but only after weighing the risk of adverse events.

Lead author, Professor  Ian Yang, Thoracic Physician  and Director of Thoracic Medicine at The Prince Charles Hospital, Brisbane, said, ‘This systematic review updates, for completeness,  the now somewhat historical clinical trials that tested inhaled steroids alone versus placebo in people with COPD.’

Professor Yang who is also Head of the Northside Clinical Unit at The University of Queensland, Brisbane, and one of two Co-Chairs of  the COPD-X Guidelines  Committee, Lung Foundation Australia, said, ‘Clinicians should consider nonpharmacological and pharmacological therapy in a stepwise approach, as recommended by the national COPD guidelines.’

This stepwise approach is available on the Lung Foundation Australia website

Professor Yang told Medicine Today that a new version of the COPD-X Guidelines was recently released by Lung Foundation Australia with two out of the 11 guideline changes likely to have a significant impact on clinical practice. The summary of changes is available on the COPD-X website (COPODX-V2-68-OCT-2022-SUMMARY-OF-CHANGES_FINAL.pdf).

Cochrane Database System Rev 2023; (3): CD002991.