Inhaled Corticosteroids in Chronic Obstructive Pulmonary Disease
Authors: E. Rand Sutherland
Journal: Annals of Internal Medicine (2003)

Letters18 November 2003Inhaled Corticosteroids in Chronic Obstructive Pulmonary DiseaseE. Rand Sutherland, MD, MPHE. Rand Sutherland, MD, MPHFrom National Jewish Medical and Research Center; Denver, CO 80206.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-139-10-200311180-00019 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:The meta-analysis by Highland and colleagues (1) evaluating inhaled corticosteroids in chronic obstructive pulmonary disease (COPD) addresses an important and controversial topic. However, certain methodologic issues may have adversely affected the validity of this analysis.First, inspection of the authors' Table 2 and forest plot suggests that a study favoring inhaled corticosteroids was incorrectly interpreted and analyzed. All studies included in the analysis reported an absolute improvement with inhaled corticosteroids, resulting in a less negative rate of decline in FEV1. Paradoxically, the authors interpreted the treatment effect from Vestbo and associates' study (2) as 3.1 mL/y (accelerated ...References1. Highland KB, Strange C, Heffner JE. Long-term effects of inhaled corticosteroids on FEV1 in patients with chronic obstructive pulmonary disease. A meta-analysis. Ann Intern Med. 2003;138:969-73. [PMID: 12809453] LinkGoogle Scholar2. Vestbo J, Sorensen T, Lange P, Brix A, Torre P, Viskum K. Long-term effect of inhaled budesonide in mild and moderate chronic obstructive pulmonary disease: a randomised controlled trial. Lancet. 1999;353:1819-23. [PMID: 10359405] CrossrefMedlineGoogle Scholar3. Derenne JP. Effects of high dose inhaled beclomethasone on the rate of decline in FEV1 in patients with chronic obstructive pulmonary disease: results of a 2 years prospective multicenter study [Abstract]. Am J Respir Crit Care Med. 1995;151:463. Google Scholar4. van Grunsven PM, van Schayck CP, Derenne JP, Kerstjens HA, Renkema TE, Postma DS, . Long term effects of inhaled corticosteroids in chronic obstructive pulmonary disease: a meta-analysis. Thorax. 1999;54:7-14. [PMID: 10343624] CrossrefMedlineGoogle Scholar5. Pauwels RA, Lofdahl CG, Laitinen LA, Schouten JP, Postma DS, Pride NB, . Long-term treatment with inhaled budesonide in persons with mild chronic obstructive pulmonary disease who continue smoking. European Respiratory Society Study on Chronic Obstructive Pulmonary Disease. N Engl J Med. 1999;340:1948-53. [PMID: 10379018] CrossrefMedlineGoogle Scholar6. Pauwels RA, Buist AS, Calverley PM, Jenkins CR, Hurd SS. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. NHLBI/WHO Global Initiative for Chronic Obstructive Lung Disease (GOLD) Workshop summary. Am J Respir Crit Care Med. 2001;163:1256-76. [PMID: 11316667] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: E. Rand Sutherland, MD, MPHAffiliations: From National Jewish Medical and Research Center; Denver, CO 80206. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoLong-Term Effects of Inhaled Corticosteroids on FEV1 in Patients with Chronic Obstructive Pulmonary Disease Kristin B. Highland , Charlie Strange , and John E. Heffner Inhaled Corticosteroids in Chronic Obstructive Pulmonary Disease Kristin B. Highland Metrics Cited byInhaled corticosteroids as combination therapy with β-adrenergic agonists in airways disease: present and futureCorticoides inhalados y supervivencia en la EPOC 18 November 2003Volume 139, Issue 10Page: 864KeywordsChronic obstructive pulmonary diseaseClinical trialsDrugsForced expiratory volume in the first second of expirationResearch designStandard error ePublished: 18 November 2003 Issue Published: 18 November 2003 Copyright & PermissionsCopyright © 2003 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...