Online Journal of Health and Allied Sciences 2002;1:1
Role of Steroids in COPD
Vishnu Sharma, K.S. Hegde Medical Academy, Deralakatte, India-575018
Citation: Sharma V. Role of Steroids in COPD. Online J Health Allied Scs. 2002;1:1
There has been a lot of debate regarding the role of steroids in the management of Chronic Obstructive Pulmonary Disease (COPD). Now with a better understanding of the pathophysiology of COPD, the role of steroids in the management of COPD has become clearer.
With proper medication the airflow obstruction in COPD can be partly relieved. Hence now COPD is defined as a disease of the lung characterised by air flow limitation that is not fully reversible. (1) The air flow limitation is usually both progressive and associated with an abnormal inflammatory response of the lung to noxious particles or gases. The airway inflammation in COPD is mediated by CD8 T lymphocytes. The airways are infiltrated by neutrophils.(2) Because of this inflammation, several studies have examined the effect of gluco corticosteroids in COPD patients, both oral and by inhaled routes.
Most studies in COPD were aimed at detecting the usefulness of gluco corticosteroids in COPD in slowing down the progression of the disease (3) i.e. either to improve FEV1, or reduce the ongoing decline in FEV1. Survival in COPD correlates directly with the level of FEV1.(4)
Oral Steroids do not change airway hyper responsiveness. (5,6) Several studies have shown that oral steroids in patients with an acute exacerbation of COPD are effective in reducing symptoms and improving lung function.(5,6) They lead to early recovery. Patients with COPD respond to oral steroids during exacerbations but not necessarily during the stable state of the disease.(5,7)
Inhaled steroids in COPD patients showed substantial improvement in lung function in some of the subjects.(2) Those patients with an asthmatic component to their disease appear to benefit most from inhaled steroids and long-term inhaled corticosteroids can decrease the number of exacerbations and reduce respiratory symptoms.(7) High dose inhaled corticosteroids have a favourable risk/benefit ratio in patients with advanced disease, particularly those with frequent exacerbations, and no benefit for those with very mild disease.(8)
Inhaled steroids: Regular treatment with inhaled gluco corticosteroids is only appropriate for patients with symptomatic improvement and a documented spirometric response to inhaled gluco corticosteroids or FEV1 <50% predicted and repeated exacerbation requiring treatment with antibiotics or oral gluco corticosteroids.
Prolonged treatment with inhaled steroids may relieve symptoms in this carefully selected group of patients but does not modify the long term decline is FEV1. The dose response relationships and long term safety of inhaled steroids in COPD are not known.
Oral gluco corticosteroids - In acute severe exacerbation of COPD if baseline FEV1<50% predicted, oral prednisolone 40mg/day for 10 days can be given. This enhances the early recovery.