Administration of Inhaled
Corticosteroids (ICS) in Chronic Obstructive Pulmonary Disease (COPD) has
always remained controversial because of its questionable benefit in this
disease. Although several clinicians believe that corticosteroids have little
or no role in controlling inflammation in COPD, its use in stable to heavilyexacerbated COPD has been in practice especially in the developing countrieswhere COPD is often over diagnosed/ underdiagnosed or misdiagnosed. Neutrophils
being the crucial players in inflammation in COPD, steroids are considered to
have a less functional effect on this type of inflammation as steroids
especially glucocorticoids has been shown to enhance the survival of
neutrophils and increase their functional responsiveness. Therefore, such
treatment might lead to incurring detrimental effects on the patients by
enhancing the exacerbation.
Although some evidence have
suggested that some drugs such as β2-agonists, methylxanthines (theophylline)
or antibiotics (macrolides) may somewhat facilitate corticosteroid sensitivity
in COPD, their functional aspects and clinical relevance are not quite clear.
Moreover, since the effect of ICS may be modulated by these other add-on drugs,
the effect of ICS alone in COPD has remained questionable. Most of the studies
showed that ICS alone does not effectively reverse the progressive decline of
FEV1 or mortality in patients with COPD. The TOwards a Revolution in COPD
Health (TORCH) trial showed higher mortality among COPD patients treated with
ICS alone than those who received ICS (Inhaled Corticosteroids) +LABA (Long
acting β2-agonists).(Read more)
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