Inhaled corticosteroids in patients with stable chronic obstructive pulmonary disease

A systematic review and meta-analysis

M. Bradley Drummond, Elliott C. Dasenbrook, Marshall W. Pitz, David J. Murphy, Eddy Fan

Research output: Contribution to journalArticle

Abstract

Context: Recent studies of inhaled corticosteroid (ICS) therapy for managing stable chronic obstructive pulmonary disease (COPD) have yielded conflicting results regarding survival and risk of adverse events. Objective: To systematically review and quantitatively synthesize the effects of ICS therapy on mortality and adverse events in patients with stable COPD. Data Sources: Search of MEDLINE, CENTRAL, EMBASE, CINAHL, Web of Science, and PsychInfo through February 9, 2008. Study Selection: Eligible studies were double-blind, randomized controlled trials comparing ICS therapy for 6 or more months with nonsteroid inhaled therapy in patients with COPD. Data Extraction: Two authors independently abstracted data including study characteristics, all-cause mortality, pneumonia, and bone fractures. The I2 statistic was used to assess heterogeneity. Study-level data were pooled using a random-effects model (when I2≥50%) or a fixed-effects model (when I 22=0%). In the trials with data on pneumonia, ICS therapy was associated with a significantly higher incidence of pneumonia (777 cases among 5405 patients in the treatment group and 561 cases among 5371 patients in the control group; RR, 1.34; 95% CI, 1.03-1.75; P=.03; I2=72%). Subgroup analyses indicated an increased risk of pneumonia in the following subgroups: highest ICS dose (RR, 1.46; 95% CI, 1.10-1.92; P=.008; I2=78%), shorter duration of ICS use (RR, 2.12; 95% CI, 1.47-3.05; P2=0%), lowest baseline forced expiratory volume in the first second of expiration (RR, 1.90; 95% CI, 1.26-2.85; P=.002; I2=0%), and combined ICS and bronchodilator therapy (RR, 1.57; 95% CI, 1.35-1.82; P2=24%). Conclusions: Among patients with COPD, ICS therapy does not affect 1-year all-cause mortality. ICS therapy is associated with a higher risk of pneumonia. Future studies should determine whether specific subsets of patients with COPD benefit from ICS therapy.

Original languageEnglish (US)
Pages (from-to)2407-2416
Number of pages10
JournalJournal of the American Medical Association
Volume300
Issue number20
DOIs
StatePublished - Nov 26 2008

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Chronic Obstructive Pulmonary Disease
Meta-Analysis
Adrenal Cortex Hormones
Pneumonia
Therapeutics
Mortality
Information Storage and Retrieval
Bronchodilator Agents
Bone Fractures
Forced Expiratory Volume
Double-Blind Method
MEDLINE
Randomized Controlled Trials
Control Groups
Survival
Incidence

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Inhaled corticosteroids in patients with stable chronic obstructive pulmonary disease : A systematic review and meta-analysis. / Drummond, M. Bradley; Dasenbrook, Elliott C.; Pitz, Marshall W.; Murphy, David J.; Fan, Eddy.

In: Journal of the American Medical Association, Vol. 300, No. 20, 26.11.2008, p. 2407-2416.

Research output: Contribution to journalArticle

Drummond, M. Bradley ; Dasenbrook, Elliott C. ; Pitz, Marshall W. ; Murphy, David J. ; Fan, Eddy. / Inhaled corticosteroids in patients with stable chronic obstructive pulmonary disease : A systematic review and meta-analysis. In: Journal of the American Medical Association. 2008 ; Vol. 300, No. 20. pp. 2407-2416.
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abstract = "Context: Recent studies of inhaled corticosteroid (ICS) therapy for managing stable chronic obstructive pulmonary disease (COPD) have yielded conflicting results regarding survival and risk of adverse events. Objective: To systematically review and quantitatively synthesize the effects of ICS therapy on mortality and adverse events in patients with stable COPD. Data Sources: Search of MEDLINE, CENTRAL, EMBASE, CINAHL, Web of Science, and PsychInfo through February 9, 2008. Study Selection: Eligible studies were double-blind, randomized controlled trials comparing ICS therapy for 6 or more months with nonsteroid inhaled therapy in patients with COPD. Data Extraction: Two authors independently abstracted data including study characteristics, all-cause mortality, pneumonia, and bone fractures. The I2 statistic was used to assess heterogeneity. Study-level data were pooled using a random-effects model (when I2≥50{\%}) or a fixed-effects model (when I 22=0{\%}). In the trials with data on pneumonia, ICS therapy was associated with a significantly higher incidence of pneumonia (777 cases among 5405 patients in the treatment group and 561 cases among 5371 patients in the control group; RR, 1.34; 95{\%} CI, 1.03-1.75; P=.03; I2=72{\%}). Subgroup analyses indicated an increased risk of pneumonia in the following subgroups: highest ICS dose (RR, 1.46; 95{\%} CI, 1.10-1.92; P=.008; I2=78{\%}), shorter duration of ICS use (RR, 2.12; 95{\%} CI, 1.47-3.05; P2=0{\%}), lowest baseline forced expiratory volume in the first second of expiration (RR, 1.90; 95{\%} CI, 1.26-2.85; P=.002; I2=0{\%}), and combined ICS and bronchodilator therapy (RR, 1.57; 95{\%} CI, 1.35-1.82; P2=24{\%}). Conclusions: Among patients with COPD, ICS therapy does not affect 1-year all-cause mortality. ICS therapy is associated with a higher risk of pneumonia. Future studies should determine whether specific subsets of patients with COPD benefit from ICS therapy.",
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