Inhaled Corticosteroids for COPD: Are Inhaled Corticosteroids Required in the Management of COPD?

Abstract

Inhaled corticosteroids (ICSs) strongly suppress airway inflammation and are widely used as the first drugs of choice for the treatment of bronchial asthma. Chronic obstructive pulmonary disease (COPD) is also an inflammatory disease of the airway, but because the type of inflammation in COPD differs from the type of inflammation in asthma and because pathology that diminishes the effectiveness of steroids is postulated in COPD, the therapeutic effect of ICSs in COPD is limited. In fact, there are many negative opinions in regard to the preventive effect of ICSs on the progression of COPD and in regard to their effectiveness in lowering mortality. Although ICS effectiveness in preventing exacerbations and effectiveness in preventing decreased quality of life (QOL) have been reported, it has also been reported that no difference in exacerbation-preventing effect was observed when the results of treatment with ICS/long-acting β agonist (LABA) and long-acting muscarinic antagonist (LAMA) were compared, and that when ICSs were gradually discontinued in COPD patients being treated with ICS/LABA/LAMA, the results showed no increase in exacerbation frequency. When selecting COPD patients for treatment with ICSs, it is necessary to consider not just the benefits of treatment, but overtreatment, increased cost, and risk of pneumonia as well.