Inhaled corticosteroids not only modestly effective in preventing COPD exacerbations

January 01, 0001

Inhaled corticosteroids not only modestly effective in preventing COPD exacerbations

Inhaled corticosteroids (ICS) are widely used to decrease the occurrence of COPD exacerbations. These Indian researchers examined efficacy of ICS in relationship of to baseline lung function via a metaregression. They searched the PubMed, EmBase, and Cochrane Central Database of Controlled Trials databases (1988-2008) for studies involving the ICS vs placebo in preventing COPD exacerbations. The risk ratio (RR from individual studies was pooled using a random-effects model to assess the exacerbations in the two groups. They also performed a weighted random effects metaregression using FEV1 values at baseline.

The authors found: "Our search yielded 11 studies (8,164 patients). The use of ICS was associated with reduction in the occurrence of exacerbations (RR, 0.82). There was the presence of significant statistical heterogeneity but no evidence of publication bias. Sensitivity analysis revealed benefit of ICS only in patients with FEV1 less than 50% (RR, 0.79) with persistence of statistical heterogeneity. Metaregression showed that the percentage risk reduction in exacerbations with the use of ICS is invariant across the severity of COPD (assessed by FEV1)."

The authors concluded: "There is only a modest benefit of ICS in preventing COPD exacerbations, which is not related to the level of baseline lung function on metaregression analysis. The benefits of ICS in preventing COPD exacerbations thus seem to be overstated."

This metaregression suggests both that ICS may not be as effective at preventing COPD exacerbations as thought and that its benefit is independent of baseline lung function.

For the full abstract, click here.

Chest 137(2): 318-325, February 2010 © 2010 American College of Chest Physicians
Inhaled Corticosteroids vs Placebo for Preventing COPD Exacerbations- A Systematic Review and Metaregression of Randomized Controlled Trials. Ritesh Agarwal, Ashutosh N. Aggarwal, Dheeraj Gupta, and Surinder K. Jindal. Correspondence to Ritesh Agarwal: [email protected]

Category: R. Respiratory. Keywords: COPD, COPD exacerbations, inhaled corticosteroid, prevention, baseline lung function, metaregression, journal watch.
Synopsis edited by Dr Paul Schaefer, Toledo, Ohio. Posted on Global Family Doctor 16 March 2010

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.