Inhaled steroids decrease inflammation in COPD but adding LABAs may not enhance these effects

Inhaled corticosteroids (ICSs) and long-acting β2-agonists (LABAs) are used to treat moderate to severe chronic obstructive pulmonary disease (COPD).

This randomized trial, published in the Annals of Internal Medicine, investigated whether long-term ICS therapy, with and without LABAs, reduces inflammation and improves pulmonary function in COPD.

The stuyd included 114 steroid-naive current or former smokers with moderate to severe COPD.

101 patients were greater than 70% adherent to therapy. Fluticasone therapy decreased counts of mucosal CD3+ cells, CD4+ cells, CD8+ cells and mast cells and reduced hyperresponsiveness, with effects maintained after 30 months.

Reductions in inflammatory cells correlated with clinical improvements in FEV1 decline, dyspnea, and quality of life.

Discontinuing fluticasone therapy at 6 months increased counts of CD3+ cells, mast cells, and plasma cells and worsened clinical outcome. Adding salmeterol improved FEV1 level.

The authors concluded that ICS therapy decreases inflammation and can attenuate decline in lung function in steroid-naive patients with moderate to severe COPD. Adding LABAs does not enhance these effects.

Update from Thorax 2012: Clearing the air: LABA/ICS reduce asthma hospitalizations, not associated with life-threatening events and deaths


Effect of Fluticasone With and Without Salmeterol on Pulmonary Outcomes in Chronic Obstructive Pulmonary Disease. Ann of Int Med, October 20, 2009, vol. 151 no. 8 517-527.
Frequent exacerbations in COPD: What to do? BMJ 10-minute consultation, 2011.
Image sources: Wikipedia, public domain, Advair Diskus.

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