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Editorials |

Steroids in COPD : The Nearly Eternal Question

Nicholas R. Anthonisen, MD
Author and Funding Information

Affiliations: Winnipeg, Manitoba, Canada 
 ,  Dean, Faculty of Medicine, University of Manitoba.

Affiliations: Winnipeg, Manitoba, Canada 
 ,  Dean, Faculty of Medicine, University of Manitoba.



Chest. 1999;115(1):3-4. doi:10.1378/chest.115.1.3
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Extract

Therapeutic trials of corticosteroids in stable COPD have been going on for 40 years,1 and the occasion for this editorial is another such trial in this issue of CHEST (see page 31), a good indication that the role of steroids in COPD is not yet settled. Why is this the case? First, steroids unquestionably work in asthma, and asthma has features in common with COPD, therefore, steroids “ought” to work in COPD. However, one could argue that the only trials that have shown unequivocally positive results were trials that did not exclude asthmatics.2,,3 Second, many of the trials in patients fulfilling stringent criteria for COPD have shown substantial short-term benefit in some 15 to 30% of subjects;4,,5 these benefits seemed too large to be accounted for by random variation, and were not predictable on the basis of the usual baseline characteristics, including those thought to relate to asthma. Third and finally, the advent of inhaled steroid preparations has substantially lowered the risk of steroid therapy, so that the size of a practically useful benefit has decreased. Indeed, in many areas of North America at least, the use of inhaled steroids in COPD has become widespread in the absence of clear evidence of benefit.


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