SELECTED ARTICLES FROM THE RECENT LITERATURE 2004

9/15/04

Inhaled corticosteroid therapy in asthma and COPD

Summary
Background - Inhaled corticosteroids (ICS) have been used extensively in asthma and to a lesser extent in COPD. However, a review of their use and effects by very experienced observers would help put this treatment approach in perspective.

Findings - Larj and Bleecker of Wake Forest Univ. School of Medicine in Winston-Salem NCb pointed out that ICS therapy benefits most patients with persistent asthma, including reduced symptom severity and bronchial hyper-responsiveness, improved pulmonary function and reduced frequency of acute asthma exacerbations. ICS treatment decreases bronchial wall inflammation and bronchial epithelium abnormalities, possibly preventing airway wall remodeling. These beneficial effects of ICS are more impressive than seen with monotherapy, with inhaled beta agonists or a leukotriene antagonist (e.g. montelukast). Addition of an inhaled long acting beta agonist (LABA) to ICS therapy generally leads to greater improvement in asthma than ICS alone, even in higher doses.

The therapeutic value of ICS therapy in COPD is less clear with variable findings in different studies. A combination of ICS and LABA may be more effective than ICS monotherapy in most COPD patients, as manifested by greater increases in the FEV-1.

Reference
Chest 2004;126:138S-149S

Editor's Comments
These comments by a respected group are pretty much in line with those expressed by other experienced clinical investigators of asthma. These principles are apparently being heard more and more by primary care physicians (PCP) with a combination of ICS and LABA being prescribed for asthma in 25-30% of asthma -related visits to PCP. The role of ICS therapy in COPD is less defined.

 

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