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Inhaled Corticosteroids Not Effective For Mild, Moderate COPD LONDON, ENGLAND -- May 28, 1999 -- Although corticosteroids are widely used (for example, in inhalers) and regarded as standard therapy for asthma, their long-term use is not based on evidence in chronic obstructive pulmonary disease (COPD), which includes chronic bronchitis and pulmonary emphysema and is characterised by persistent breathing difficulties. The main aim of treatment for COPD is to decrease the rate of decline in lung function (measured by the forced expiratory volume in 1 s [FEV1]) and to reduce respiratory symptoms. In The Lancet this week, Dr. Jorgen Vestbo and colleagues from Denmark assessed the effects of budesonide (an inhaled corticosteroid) on the rate of FEV1 decline in 290 patients with COPD who did not have asthma. In the study, 145 patients received budesonide (inhaled through an inhaler) and 145 received matched placebo (lactose powder that was inhaled in the same way as the study drug, the control group). The researchers found that budesonide had no significant effect on the rate of decline in lung function in treated patients (46.0 ml per year) compared with controls (49.1 ml per year) -- an overall difference of 3(sum)1 ml (a minimum difference of 20 ml between the two groups would have been significant). They found that respiratory symptoms decreased substantially during the study period, but there were no differences between the groups. 11 patients in the budesonide group and eight in the placebo group had side-effects that resulted in their withdrawal from the study. The numbers of patients who had worsening of their disease and occurrence of pneumonia was also similar between the two groups. Vestbo and colleagues conclude that inhaled budesonide has no clinical benefit in these patients and so question the role of long-term inhaled corticosteroids in the treatment of mild to moderate COPD. "Differentiation between asthma and COPD is therefore even more important in the daily clinical setting, and we should emphasise that cessation of smoking is still the only intervention with proven long-term efficacy of FEV1 decline in COPD," they write. Related Links: The Lancet E-mail this page to a friend or colleague! To print, use this version