A new study finds that a common type of drug used for people with chronic lung disease may not help them. Researchers put together the results from 11 previous studies. The studies included 8,164 people with chronic obstructive pulmonary disease. This condition gradually destroys the lungs. Drugs can treat symptoms, but there is no cure. In the studies, people were randomly assigned to take inhaled corticosteroid drugs or placebos. Researchers found that the drugs had only a small effect in reducing flare-ups. Even this benefit occurred only in people with the most severe illness. The study appeared in the journal Chest. HealthDay News wrote about it February 4.

By Howard LeWine, M.D.
Harvard Medical School

What Is the Doctor's Reaction?

Chronic obstructive pulmonary disease (COPD) has traditionally included two lung conditions -- chronic bronchitis and emphysema. Often people with COPD have both. Some experts suggest that the definition of COPD should be changed. Instead, they propose treating COPD as one disease, defined as loss of airflow that cannot be reversed.

Treatment options for COPD are very limited. And those that do work only help decrease symptoms. They can't reverse the lung damage that has already occurred. They can't even slow down the rate of future lung damage.

On a more positive note, some inhaled medicines can help to reduce how often COPD flare-ups occur. Doctors call these COPD exacerbations. The inhaled drugs most commonly used are:

• Long-acting beta agonists, such as salmeterol (Serevent) and formoterol. These drugs help keep airways open.
• Anti-cholinergic agents, such as ipratropium (Atrovent) and tiotropium (Spiriva). These drugs also help keep airways open. Some experts believe they are slightly more effective than long-acting beta agonists for COPD.
• Corticosteroids, such fluticasone (Flovent) and many others. Inhaled corticosteroids decrease inflammation in the airways.

Many people with COPD use an inhaler that combines a long-acting beta agonist to open the airways and a corticosteroid. Two examples are Advair and Symbicort.

In this month's issue of the journal Chest, researchers looked at how effective inhaled corticosteroids are for COPD. This study analyzed the combined results of previous research. Specifically, researchers looked at this question: "Do people have fewer flare-ups of COPD if they use an inhaled corticosteroid daily?" The question is important because people with COPD who inhale corticosteroids daily have a higher risk of pneumonia than those who don't use them.

The researchers' findings suggest that inhaled corticosteroids do not prevent flare-ups in COPD, except in a minority of cases. However, many people with COPD still could benefit from these drugs. The study just found that on average they didn't help.

What Changes Can I Make Now?

Smoking is the major cause of COPD. More than 80% of people with the disease are present or past smokers. Quitting smoking is the only chance you have to prevent COPD from getting worse.

If your doctor has prescribed a corticosteroid inhaler, do not stop using it based on the results of this study.

There are people with COPD who will have fewer flare-ups while using a corticosteroid inhaler. They also will cough less and have less shortness of breath.

The people with COPD who are likely to get the most benefit from an inhaled corticosteroid have:

• Airways that can open up when they take a drug designed to do just that.
• Airways that produce a lot of mucous because of inflammation. People with pure emphysema don't have inflamed airways. Many people with chronic bronchitis do.

What Can I Expect Looking to the Future?

Your doctor probably will not make any immediate changes based on this study. The main reason is that inhaled long-acting beta agonists to keep airways open are usually prescribed in combination with an inhaled corticosteroid. There is some evidence that using the beta agonist without the corticosteroid increases the risk of abnormal heart rhythms.

Therefore, if the corticosteroid is stopped, the inhaled long-acting beta agonist might need to be stopped as well.

Sound confusing? It is. Stay tuned, but meanwhile there's no need to make any immediate changes.