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Evid Based Med 2009;14:74 doi:10.1136/ebm.14.3.74
  • Therapeutics

Review: inhaled corticosteroids do not reduce mortality but increase pneumonia in COPD

QUESTION

In patients with stable chronic obstructive pulmonary disease (COPD), what are the harms and benefits of inhaled corticosteroid (ICS) therapy?

REVIEW SCOPE

Included studies compared an ICS with placebo or other inhaled medications in patients ≥40 years of age with stable COPD. Outcomes were all-cause mortality at 1 and 3 years, pneumonia, and fractures.

REVIEW METHODS

Medline, EMBASE/Excerpta Medica, Cochrane Central Register of Controlled Trials, CINAHL, Web of Science, and PsycINFO (all to Feb 2008); and references were searched for published, double-blind, randomised controlled trials (RCTs) with duration ≥6 months. 11 RCTs (14 comparisons, n = 14 426) met the selection criteria. 8 comparisons were placebo-controlled; most other trials compared an ICS plus a long-acting β2-agonist (LABA) with the LABA alone. 7 trials …

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