Past Online Articles Create username. It's a scandal, a disgrace, and it's got to stop. Dr. Barnes bases his strong opinions on his investigations into the cellular mechanisms of the disease, where he and his colleagues found different inflammatory pictures for COPD and asthma. Although their journey into the world of eosinophils, macrophages, cytokines and genes has not yet provided a complete snapshot of COPD, they learned that COPD patients appear to have high levels of oxidative stress, and this could be the source of steroid resistance.
Neutrophilic inflammation is another apparently steroid-resistant component of the COPD picture.
Inflammation is not suppressed by steroids, even at high doses. Dr. Barnes' tough words for American physicians stem from his belief that they prescribe inhaled steroids for stable COPD patients even though they have no evidence that the medication improves the clinical status of their patients. In light of Dr. Barnes' research, such standard of care would appear to be an exercise in futility, and an expensive one at that. An American voice sharing Dr. Barnes' opinion that doctors overprescribe inhaled steroids for stable COPD patients in the United States is Sonia Buist, MD, of Portland, Ore., an investigator on the comprehensive Lung Health Study. Reporting data from the Lung Health Study 2 in Toronto, Dr. Buist acknowledges that investigators could not identify any characteristic showing benefit from steroid therapy in stable COPD patients.