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New study allays fear over inhaled steroids

Long-term use of inhaled

corticosteroids in patients with asthma or COPD does not lead to a significant decrease in bone mineral density, a new US study reveals.

The finding, based on a meta-analysis of 14 studies, helps allay fears that inhaled corticosteroids could have similar effects to oral corticosteroids, which are known to decrease BMD.

It also further supports the case for GPs not to restrict prescribing of inhaled corticosteroids to patients with severe COPD ­ as recommended in draft guidelines from the National Institute for Clinical Excellence.

A US Government-funded study reported in Pulse last week revealed inhaled steroids slow lung function decline in all patients with COPD, not just those with severe disease as traditionally thought.

The latest study, presented last month to the annual meeting of the American College of Chest Physicians in Orlando, showed over the course of one year, inhaled corticosteroid therapy had no statistically significant effect on BMD in adults.

Inhaled steroid users showed a change in BMD equivalent to that seen in a normal adult population in the 14 studies, which met strict criteria including the use of moderate to high doses of inhaled steroids and having at least one year of follow-up.

General Practice Airways Group member and Glasgow GP Dr John Haughney said: 'It is known oral steroids cause problems in the long-term with osteoporosis and so on. This is another reassurance about the safety of inhaled steroids.

'We hear too much about the possible dangers of high doses of inhaled steroids and not the enormous benefit of normal doses.'

However, the longest follow-up in the studies analysed was four years and researchers acknowledged that after a decade of inhaled steroid

use the outcome could be

different.

The second NICE draft guidelines on COPD, released last week, show no substantial change from the first draft and continue to tell GPs to limit inhaled steroids to the most severe COPD patients.

However, a spokesman for NICE said the new meta-analysis published in Thorax (November), which found low-dose inhaled steroids reduced the rate of FEV1 decline by an average of 7.7ml/year, could be taken into account in the final guidelines due to be published in February.

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