D

Fig. 10.3 The excessive decline in forced expiratory volume in 1s (FEV1) in COPD (a), the theoretical benefit of an effective intervention (b), the effect of smoking cessation (c), and the effect of inhaled corticosteroids in the European Respiratory Society Study on Chronic Obstructive Pulmonary Disease (EUROSCOP) and Inhaled Steroids in Obstructive Lung Disease in Europe (ISOLDE) studies (d).

were substantial with regard to costs per symptom-free day [33]. The results have, however, only been presented in abstract form and are based on the very positive 6-month study. With the lack of effect in the long-term studies in patients with mild to moderate COPD, it seems highly unlikely that ICS can be cost-effective without proper selection of patients. More data are, nevertheless, clearly needed.

There is no doubt that exacerbations are costly, especially when requiring hospitalization in patients with severe disease [34], but inferences from the ISOLDE study are difficult to make at present, as no data on the frequency of hospitalization in the ISOLDE study are available.

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