Corticosteroids In COPD Summary
The use of inhaled corticosteroids in COPD
In this study published in JAMA, the authors looked at eleven studies on the use of inhaled corticosteroids in patients with COPD defined as a smoking- related lung disease characterized by recurrent episodes of cough, sputum production and breathlessness (Drummond, 2407). The authors of this study did no research of their own, but instead looked at other double blind, randomized, placebo controlled studies from around the world, with a restriction that the study was published, lasted longer than six months and looked at ICS use compared to a control group (2408). These were searched for using medical databases and the reference sections of studies they considered. Two reviewers independently screened …show more content…
As the studies all used different inhaled steroids at different doses, all were converted to the equivalent dose of beclomethasone, with conversion disagreements again settled by consensus (2408) . This means that there again was study bias as the conversion is not an exact similar dose. Not all the studies used matched all the criteria, including placebo control, combo therapy with a long acting beta agonist (LABA) and steroid alone trials. (2409) I myself found this to be very confusing as you never know which study provided which results, and how these results were interpreted. However, no study found a statistically significant 1-year mortality benefit from ICS use as compared with placebo …show more content…
Three of the studies reported fracture events. (2412). In the control group, there were 178 events among 4058 subjects and in the ICS group there was 195 events in 4037 subjects. (2412). Looking at these numbers there was no statistical difference among the two groups, so increased fractures were not the result of ICS use.
Of note the studies did reveal that six month or greater use of ICS therapy did slow the rate of decline and therefore improve the quality of life of the COPD patients as measured by the St. George’s Respiratory Questionnaire. However different quality of life measurements were also used in all eleven studies (2414).
In conclusion there were many issues with this meta-analysis. First, multiple studies were looked at, but not all studies were used to measure each outcome. This means the results are skewed based on which trial was used compared to an overall result. Secondly, different definitions were used in all the trials, so that means that the results really can not be compared to each other accurately. Finally while most studies showed quality of life improved while taking ICS therapy, we don’t really know how much and in what ways, as these were again measured differently in each
In this study published in JAMA, the authors looked at eleven studies on the use of inhaled corticosteroids in patients with COPD defined as a smoking- related lung disease characterized by recurrent episodes of cough, sputum production and breathlessness (Drummond, 2407). The authors of this study did no research of their own, but instead looked at other double blind, randomized, placebo controlled studies from around the world, with a restriction that the study was published, lasted longer than six months and looked at ICS use compared to a control group (2408). These were searched for using medical databases and the reference sections of studies they considered. Two reviewers independently screened …show more content…
As the studies all used different inhaled steroids at different doses, all were converted to the equivalent dose of beclomethasone, with conversion disagreements again settled by consensus (2408) . This means that there again was study bias as the conversion is not an exact similar dose. Not all the studies used matched all the criteria, including placebo control, combo therapy with a long acting beta agonist (LABA) and steroid alone trials. (2409) I myself found this to be very confusing as you never know which study provided which results, and how these results were interpreted. However, no study found a statistically significant 1-year mortality benefit from ICS use as compared with placebo …show more content…
Three of the studies reported fracture events. (2412). In the control group, there were 178 events among 4058 subjects and in the ICS group there was 195 events in 4037 subjects. (2412). Looking at these numbers there was no statistical difference among the two groups, so increased fractures were not the result of ICS use.
Of note the studies did reveal that six month or greater use of ICS therapy did slow the rate of decline and therefore improve the quality of life of the COPD patients as measured by the St. George’s Respiratory Questionnaire. However different quality of life measurements were also used in all eleven studies (2414).
In conclusion there were many issues with this meta-analysis. First, multiple studies were looked at, but not all studies were used to measure each outcome. This means the results are skewed based on which trial was used compared to an overall result. Secondly, different definitions were used in all the trials, so that means that the results really can not be compared to each other accurately. Finally while most studies showed quality of life improved while taking ICS therapy, we don’t really know how much and in what ways, as these were again measured differently in each