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Steroids May Be Overrated in Treatment of COPD
Date:2/4/2010

ne at the Postgraduate Institute of Medical Education and Research in Chandigarh, India, looked at 11 studies that compared inhaled corticosteroids with placebos in some 8,164 COPD patients.

The researchers found that these drugs only had a modest effect in reducing the number of exacerbations. In fact, even this small benefit was limited to patients who had lost more than 50 percent of their lung function.

Yet, further analysis of the data found that even 50 percent of lung function was not a predictor of the ability of inhaled corticosteroids to reduce the number of exacerbations, Agarwal's team found.

Given these findings, the researchers say that "the role of inhaled corticosteroids in preventing COPD exacerbations needs reappraisal."

However, Dr. Neil Schachter, a professor of pulmonary medicine at Mount Sinai Medical Center in New York City, isn't ready to give up on inhaled corticosteroids.

"There does appear to be an improvement in terms of the rate of exacerbations of patients with COPD who take drugs that contain corticosteroids," he said. "That confirms what most people believe, that if you treat COPD with most of the drugs we use to treat it, you can reduce and delay the onset of exacerbations."

Schachter treats most of his COPD patients with a combination of drugs. Many patients take inhaled corticosteroids, long-acting beta agonists and the anticholinergic Spiriva. He said the effects of these drugs are additive, making for a more powerful treatment than using a single drug.

"My bias is to use everything," he said. "My impression is that these patients do better on triple therapy. They have better lives, less symptoms, fewer exacerbations and they probably live a bit longer."

Another report in the same issue of the journal found that COPD patients have a high rate of depression. In this study, a research team led by Christoph R. Meier, from University Basel in Switzerland,
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