No abstract

Background: Chronic obstructive pulmonary disease (COPD) is a syndrome of chronic progressive airflow limitation which occurs as a result of chronic inflammation of the airways and lung parenchyma. However, the role of inhaled corticosteroids in the treatment of COPD is controversial. We hypothesised that inhaled corticosteroids reduce the progression of airflow limitation in COPD. Methods: A comprehensive literature search was conducted and data were analysed using random effects methodology. The effect of inhaled steroids on annual change in forced expiratory volume in 1 second (FEV 1 ) was determined for all trials, for trials with high dose treatment regimens, and for trials in subjects with moderate to severe airflow limitation. Results: Data from eight controlled clinical trials of >2 years were included (n = 3715 subjects). Metaanalysis of all study data revealed that inhaled corticosteroids reduce the rate of FEV 1 decline by 7.7 ml/ year (95% confidence interval (CI) 1.3 to 14.2, p = 0.02). Meta-analysis of studies with high dose regimens revealed a greater effect of 9.9 ml/year (95% CI 2.3 to 17.5, p = 0.01) compared with the meta-analysis of all studies. Conclusions: Inhaled corticosteroid treatment for >2 years slows the rate of lung function decline in COPD. The effect observed with high dose regimens is greater than that with all regimens combined. These data suggest a potential role for inhaled corticosteroids in modifying the long term natural history of COPD.

The obtained data from TIP reveal remarkable pertinent options for interdisciplinary pt-management in severe OSD in all risk-professions.

The follow-up survey 9 months after the beginning of the program (response rate: IG: N = 163, 75.8%; CG: N = 80, 94.1%) showed that 71.8% (N = 117) of the intervention group could remain in work as opposed to 60.0% (N = 48) in the control group. In the intervention group 14.7% gave up work due to OSD versus 22.5% in the control group (no statistically significant effect). In the 5-year follow-up (response rate: IG: N = 172, 80%; CG: N = 55, 64.7%) 58.7% (N = 101) of the IG remained at work versus 29.1% (N = 16) of the CG. In the IG 12.8% had stopped work because of OSD versus 27.3% in the CG (p < 0.001, Cramer's V = 0.26). Ten years after intervention, the follow-up showed a stabilization of the effects shown by the 5-year follow-up results. In addition to the criteria 'remaining' or 'not remaining at work' the results show that our interdisciplinary intervention program led to an increased and sustained knowledge on OSD and more adequate prevention at the work place in the IG. The results confirm that interdisciplinary training can be successful in effecting self-protection against workplace hazards by using positive approaches that include the learning of "safe" behavior and insuring transferability to real workplace settings ("empowerment"). Combined preventive measures as studied in this program have recently become the standard offered by different statutory accident liability insurances for patients in different wet work occupations with OSD in Germany.

No abstract