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Thinning Bone and Inhaled Corticosteroid in COPD: What To Do Until There Is Definitive Proof?

S. F. Paul Man, MD, FCCP; Don D. Sin, MD, FCCP
Author and Funding Information

Correspondence to: S. F. Paul Man, MD, FCCP, Professor of Medicine, the University of British Columbia, The Department of Medicine, St. Paul's Hospital, 1081 Burrard St, Vancouver, BC, Canada, V6Z 1Y6; e-mail: pman@providencehealth.bc.ca

Affiliations: Drs. Man and Sin are members of the Department of Medicine, Respiratory Division, University of British Columbia, and the Heart and Lung Institute, St. Paul's Hospital.


Financial/nonfinancial disclosures: Dr. Man has reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article. Dr. Sin has received honoraria for speaking engagements for, has received research funding from, and has served on the advisory boards of GlaxoSmithKline and AstraZeneca, makers of inhaled corticosteroids.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).


© 2009 American College of Chest Physicians


Chest. 2009;136(6):1448-1449. doi:10.1378/chest.09-1787
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Extract

COPD is an inflammatory condition of the lung, and, over the past decade, it has been increasingly recognized for its systemic inflammation and extrapulmonary manifestations.1 The levels of common proinflammatory molecules, such as interleukin 1, interleukin 6, tumor necrosis factor α, and C-reactive protein, are elevated in the blood, and some proinflammatory molecules are present in large amounts in the lung tissues or BAL fluid.1 Whereas osteoporosis is multifactorial in its etiology, it is most commonly seen in individuals who are elderly, have chronic illnesses, or have chronic systemic inflammation.2 Biochemically, proinflammatory molecules have been shown to favor a loss of bone mineralization.3 Unfortunately, patients who have moderate-to-severe COPD have many of the clinical features that predispose them to osteoporosis, by virtue of being elderly or chronically disabled, and having chronic systemic inflammation.

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