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Steroids are 'overused and risky' in COPD

Patients with COPD who use

inhaled steroids are at substantially increased risk of dying from pneumonia, a large-scale analysis reveals.

The epidemiological study is the first to report the association and comes amid growing doubts over the value of steroids for treating COPD.

The authors of the study, of more than a quarter of a million patients, warned inhaled steroids were 'overprescribed' for the disease despite lack of evidence for their effectiveness.

Users of inhaled steroids were 70 per cent more likely than non-users to develop pneumonia and 53 per cent more likely to suffer pneumonia hospitalisation leading to death within 30 days.

The findings follow research reported in Pulse last week claiming to provide the final

answer to the question of whether inhaled steroids altered the natural course of COPD. The answer, the researchers said, was 'no'.

Professor Pierre Ernst, leader of the new study and professor of medicine at McGill University in Canada, told Pulse: 'This

is of concern, especially given the limited information supporting the efficacy of inhaled steroids in COPD as opposed to asthma. Inhaled steroids are overprescribed in COPD despite limited efficacy and this practice is associated with certain risks.'

He urged doctors 'to remember inhaled steroids alone or in combination are not first-line or second-line therapy for COPD and the balance of efficacy and side-effects must be considered'.

NICE says inhaled steroids should be added in to bronchodilators in patients with an FEV1 =50 per cent of predicted who have had two or more exacerbations requiring treatment in a year.

Professor Ernst's study appears to confirm the suggestion of a link with pneumonia signalled by recent trials. The effect seems dose-related, with the risk greatest for doses of steroids equivalent to fluticasone 1,000mcg per day.

The study, published online by the American Journal of Respiratory and Critical Care Medicine,

followed nearly 176,000 COPD patients on inhaled steroids and 95,768 matched controls.

GP experts said the sheer number of patients involved

meant the results should be taken seriously.

Dr David Bellamy, a member of the NICE COPD guidelines group who is retiring as a GP in Bournemouth, said: 'It's certainly an interesting finding, and worrying as well.'

dcressey@cmpmedica.com

Studies question steroid use

February 2007

• TORCH study of 6,000 patients found inhaled steroids on their own had no effect on mortality in patients with COPD

• Combination of salmeterol and fluticasone propionate reduced risk of dying 17.5 per cent, but not significantly so

March 2007

• Meta-analysis of inhaled steroids in COPD found steroid use reduced FEV1 by 2.42 compared with placebo, but from six to 36 months there was no significant benefit

March 2007

• Researchers studied 176,000 COPD patients and 95,768 matched controls

• Inhaled steroids increased by 53 per cent risk of pneumonia hospitalisation leading to death within 30 days

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