Division of Pulmonary, Critical Care, Allergy and Clinical Immunology, Medical University of South Carolina, 96 Jonathan Lucas Street, 812 CSB, Box 250623, Charleston, South Carolina 29425, USA. highlakb@musc.edu
BACKGROUND: There is no consensus on the effectiveness of inhaled corticosteroids for the treatment of chronic obstructive pulmonary disease (COPD). PURPOSE: To evaluate the long-term effects of inhaled corticosteroids on the rate of FEV1 decline in patients with COPD. DATA SOURCES: MEDLINE, EMBASE, CISCOM, and AMED databases and the Cochrane Library (1966 to December 2002), reference lists from identified articles, and consultation with experts. Searches were not limited to the English language. STUDY SELECTION: Randomized, placebo-controlled trials that examined the rate of FEV1 decline as a primary outcome in patients with COPD. DATA EXTRACTION: Two reviewers independently extracted the data by using predetermined criteria. DATA SYNTHESIS: For the six studies that met the inclusion criteria, the summary estimate for the difference in FEV1 decline between the placebo and treatment groups was -5.0 +/- 3.2 mL/y (95% CI, -11.2 to 1.2 mL/y; P = 0.11). CONCLUSIONS: The use of inhaled corticosteroids was not associated with the rate of FEV1 decline in 3571 patients followed for 24 to 54 months.