Lowering COPD mortality

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Inhaled corticosteroids appear to significantly reduce mortality in patients with chronic obstructive pulmonary disease (COPD), a new study shows.

For five years, researchers at the University of Manitoba in Winnipeg studied the mortality of patients discharged from the university hospital with a diagnosis of COPD. Of the 4,022 participants, 1,629 had received corticosteroids, while 2,393 had not. Patients who died within 90 days of discharge were excluded. Results showed that in subjects older than age 65, inhaled steroids were associated with a 25% reduction in mortality in the year after discharge. In subjects aged 35-64, the mortality reduction was 53%. Both reductions were largely due to the decreased number of cardiovascular deaths, not a reduction in respiratory deaths (Chest. 2006;130:640-646).

In an accompanying editorial, two pulmonary experts state that “systemic inflammation plays an important role in the pathogenesis of atherosclerosis and plaque rupture, and corticosteroids can cool the ‘fire’ in the lungs and blood vessels of COPD patients.” But they add that before incorporating inhaled steroid therapy into clinical practice, more evidence is needed because of the study’s limitations and the unknown “clinical implications” of the therapy (Chest. 2006; 130:629-630).

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