Adverse Effects of Corticosteroid Therapy for COPD

McEvoy, Charlene; Niewoehner, Dennis E.

doi:10.1378/chest.111.3.732

Cited by 139 publications

(73 citation statements)

References 82 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Similar changes in the lung microbiome after these treatments were observed in a smaller study of 12 COPD subjects [8]. In support of reports on the limited efficacy and greater side-effects of steroids [25,26] our results suggest that steroids alone could affect the lung microbiome and underscore the importance of patient stratification approaches, such as blood eosinophil-guided prednisolone therapy [13], toward more precise drug management strategies.…”

Section: Network Analysis Reveals Potential Microbiota Interactionssupporting

confidence: 87%

Lung microbiome dynamics in COPD exacerbations

et al. 2016

View full text Add to dashboard Cite

Increasing evidence suggests that the lung microbiome plays an important role in chronic obstructive pulmonary disease (COPD) severity. However, the dynamics of the lung microbiome during COPD exacerbations and its potential role in disease aetiology remain poorly understood.We completed a longitudinal 16S ribosomal RNA survey of the lung microbiome on 476 sputum samples collected from 87 subjects with COPD at four visits defined as stable state, exacerbation, 2 weeks post-therapy and 6 weeks recovery.Our analysis revealed a dynamic lung microbiota where changes appeared to be associated with exacerbation events and indicative of specific exacerbation phenotypes. Antibiotic and steroid treatments appear to have differential effects on the lung microbiome. We depict a microbial interaction network for the lung microbiome and suggest that perturbation of a few bacterial operational taxonomic units, in particular Haemophilus spp., could greatly impact the overall microbial community structure. Furthermore, several serum and sputum biomarkers, in particular sputum interleukin-8, appear to be highly correlated with the structure and diversity of the microbiome.Our study furthers the understanding of lung microbiome dynamics in COPD patients and highlights its potential as a biomarker, and possibly a target, for future respiratory therapeutics. @ERSpublications Lung microbiome changes are associated with COPD exacerbation events and implicated in host inflammatory responses

show abstract

Section: Network Analysis Reveals Potential Microbiota Interactionssupporting

confidence: 87%

Lung microbiome dynamics in COPD exacerbations

et al. 2016

View full text Add to dashboard Cite

show abstract

“…6 Inhaled corticosteroid treatment is, however, associated with rare but potentially serious adverse events, such as osteoporosis, glaucoma, and cataract, that are diffi cult to identify in effi cacy studies. 7 Six inhaled corticosteroids are available in the United States: beclomethasone dipropionate (beclomethasone), budesonide, fl unisolide, fl uticasone propionate (fl uticasone), mometasone furoate (mometasone) and triamcinolone acetonide (triamcinolone). Table 1 summarizes their generic names, trade names, manufacturers, dosage form with corresponding devices, strengths, and labeled uses.…”

Section: 4 Inhaled Corticosteroids and Copdmentioning

confidence: 99%

Efficacy and Safety of Inhaled Corticosteroids in Patients With COPD: A Systematic Review and Meta-Analysis of Health Outcomes

Gartlehner¹

2006

The Annals of Family Medicine

111

View full text Add to dashboard Cite

PURPOSE We wanted to review systematically the effi cacy, effectiveness, and safety of inhaled corticosteroids with respect to health outcomes in patients with chronic obstructive pulmonary disease (COPD). METHODSWe searched MEDLINE, EMBASE, The Cochrane Library, and the International Pharmaceutical Abstracts to identify relevant articles. We limited evidence to double-blinded randomized controlled trials (RCTs) for effi cacy, but we also reviewed observational evidence for safety. Outcomes of interest were overall mortality, exacerbations, quality of life, functional capacity, and respiratory tract symptoms. When possible, we pooled data to estimate summary effects for each outcome.RESULTS Thirteen double-blinded RCTs determined the effi cacy of an inhaled corticosteroid compared with placebo; 11 additional studies assessed the safety of inhaled corticosteroid treatment in patients with asthma or COPD. Overall, COPD patients treated with inhaled corticosteroids experienced signifi cantly fewer exacerbations than patients taking placebo (relative risk [RR] = 0.67; 95% CI, 0.59-0.77). No signifi cant difference could be detected for overall mortality (RR = 0.81; 95% CI, 0.60-1.08). Evidence on quality of life, functional capacity, and respiratory tract symptoms is mixed. Adverse events were generally tolerable; pooled discontinuation rates did not differ signifi cantly between inhaled corticosteroid and placebo treatment groups (RR = 0.92; 95% CI, 0.74-1.14). Observational evidence, however, indicates a dose-related risk of cataract and open-angle glaucoma. Severe adverse events, such as osteoporotic fractures, are rare; the clinical importance of the additional risk is questionable.CONCLUSIONS Overall, the risk-benefi t ratio appears to favor inhaled corticosteroid treatment in patients with moderate to severe COPD. Existing evidence does not indicate a treatment benefi t for patients with mild COPD. INTRODUCTIONC hronic obstructive pulmonary disease (COPD) is among the leading causes of morbidity and mortality worldwide.1 In 2000 COPD accounted for approximately 20.7 million outpatient visits, 3.4 million emergency department visits, 6.3 million hospitalizations, and 116,513 deaths in the United States. 2 The World Health Organization estimates that by the year 2020, COPD will be the third-leading cause of death and the fi fth-leading cause of disability worldwide. COPD is characterized by a progressive, irreversible limitation of airfl ow associated with an abnormal infl ammatory response to noxious particles or gases. It is caused primarily by smoking. 3,4 Gerald Gartlehner, MD 254 INHALED CORTICOSTEROIDS AND COPDThe benefi cial effect of inhaled corticosteroid treatment for COPD remains controversial, 3,5 in part because only smoking cessation is reliably shown to slow the rate of decline in lung function. 4 Although the Food and Drug Administration (FDA) has not approved inhaled corticosteroids as monotherapy for the treatment of COPD, they are frequently prescribed to reduce or alleviate symptoms...

show abstract

“…Side effects of prolonged oral corticosteroid use are well-documented and consist of skin damage, myopathy, diabetes, cataracts and osteoporosis [7]. The older COPD population is especially susceptible to these complications.…”

mentioning

confidence: 99%

Dose dependent increased mortality risk in COPD patients treated with oral glucocorticoids

et al. 2001

View full text Add to dashboard Cite

Systemic corticosteroids are often administered in COPD patients. The relationship between systemic glucocorticoids and mortality in patients with moderate to severe chronic obstructive pulmonary disease (COPD) was retrospectively analysed. Baseline characteristics of the patients, in stable clinical condition, were collected on admission to a pulmonary rehabilitation centre. Overall mortality was asessed at the end of follow-up. The Cox proportional hazards model was used to quantify the relationship between glucocorticoid use, distinguishing administration route (oral/inhalation) and oral dose, and overall mortality, adjusted for the influence of age, sex, smoking, lung function, resting arterial blood gases and body mass index.On multivariate analysis, oral glucocorticoid use at a (prednisone equivalent) dose of 10 mg . day -1 without inhaled glucocorticoids, was associated with an increased risk (RR~2.34, 95% confidence interval (CI) 1.24 -4.44) while 15 mg . day -1 carried a relative risk of 4.03, CI~1.99 -8.15). A significant interaction was observed between inhaled and oral glucocorticoid use. Combined with inhaled glucocorticoids, the relative risk of oral glucocorticoid use appeared to be significantly smaller.It is concluded that in severe chronic obstructive pulmonary disease, maintenance treatment with oral glucocorticoids is associated with increased mortality in a dosedependent manner. Since the present study design cannot exclude the possibility of bias by indication, further prospective studies are indicated using a broader patient characterization.

show abstract

Adverse Effects of Corticosteroid Therapy for COPD

Cited by 139 publications

References 82 publications

Lung microbiome dynamics in COPD exacerbations

Lung microbiome dynamics in COPD exacerbations

Efficacy and Safety of Inhaled Corticosteroids in Patients With COPD: A Systematic Review and Meta-Analysis of Health Outcomes

Dose dependent increased mortality risk in COPD patients treated with oral glucocorticoids

Contact Info

Product

Resources

About