Corticosteroid Administration in COPD: Summary of the Global Initiative for Chronic Obstructive Lung Disease (GOLD) Guidelines 2017

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)