It will come as no surprise to practicing clinicians that inhaled corticosteroids (ICS) are widely used in the management of chronic obstructive pulmonary disease (COPD). It is the general impression that as many COPD patients as asthma patients are treated with ICS; treatment often includes high-dose ICS, is continued for years without much thought of monitoring the effect, and little is done to evaluate potential systemic side effects. The widespread use of ICS was recently documented in a Canadian survey , in which 43% of hospitalized patients using ICS were suffering from COPD and not asthma, which is the registered indication in Canada as well as in most other countries.
There are no good studies on why inhaled corticosteroids became so popular in COPD in spite of their lack of official recognition and at a time when few data on long-term effects were available. It is my belief that they were used for several reasons—many doctors believed that COPD differed very little from asthma, where inhaled corticosteroids are the front-line drug; since systemic corticosteroids have been shown to be effective in the acute exacerbation of COPD, it seemed rational to use local steroids as maintenance treatment; and finally, what else could you use once you have tested all the available bronchodilators?
Today, however, we have more data available to determine the choice of whether or not to include ICS in the treatment for COPD.
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If you suffer with asthma, you will no doubt be familiar with the uncomfortable sensations as your bronchial tubes begin to narrow and your muscles around them start to tighten. A sticky mucus known as phlegm begins to produce and increase within your bronchial tubes and you begin to wheeze, cough and struggle to breathe.