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NHLBI STUDY SHOWS INHALED CORTICOSTEROIDS DO NOT
SLOW PROGRESSION OF COPD |
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NHLBI STUDY SHOWS INHALED CORTICOSTEROIDS DO NOT
SLOW PROGRESSION OF COPD
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| Ending a long controversy about the effects of inhaled
corticosteroids in the treatment of people with chronic
obstructive pulmonary disease (COPD), researchers supported
by the National Heart, Lung, and Blood Institute (NHLBI)
today reported that inhaled corticosteroids do not slow the
progression of the disease, as many had hoped, but they do
reduce respiratory symptoms in some of these patients.
The Lung Health Study (LHS) II, which appears in the
December 28, 2000 "New England Journal of Medicine", showed
that patients treated with inhaled corticosteroids
experienced no significant slowing of the decline in lung
function that makes COPD ultimately deadly but did have
fewer symptoms, lower health care utilization, and some
improvement in the sensitivity of the lungs to external
stimuli. However, they also had a small amount of bone loss
and an increase in skin bruises compared to the placebo
group.
Said NHLBI Director Dr. Claude Lenfant, "Inhaled
corticosteroids are commonly prescribed for patients with
COPD, although their effectiveness has not been
consistently shown. These findings from LHS II provide us
with the full picture of their benefits and risks.
"Smoking cessation is the only thing shown to slow the
progression of COPD, but since this is often difficult to
achieve, we are investigating other ways to prevent its
progression," he added.
COPD is a term used for two closely related diseases of the
respiratory system: chronic obstructive bronchitis and
emphysema. It currently affects approximately 16 million
Americans and is the fourth leading cause of death in the
U.S. Research has shown that cigarette smoking is
associated with 80-90 percent of COPD cases.
Chronic airway inflammation, induced by smoking, is thought
to contribute to the development of COPD. Since inhaled
corticosteroids have been shown to reduce airway
inflammation in asthma, scientists had thought they might
slow disease progression in patients with COPD. LHS II
shows that this is not the case.
LHS II involved 1,116 participants, ages 40 to 69, with
mild to moderate COPD who were either current smokers or
smokers who had quit within the past two years.
Participants were randomly assigned to receive either an
inhaled corticosteroid or placebo. Lung function was
evaluated every six months using spirometry.
The study showed that lung function decline in the patients
treated with the inhaled corticosteroid was statistically
no different from that in the placebo group. Corticosteroid
use did, however, result in 25 percent fewer respiratory
symptoms and nearly 50 percent fewer outpatient visits for
respiratory problems. However, after three years, bone
density in the hip and back was lower in the corticosteroid
group.
Said Dr. Robert Wise, Professor of Medicine at Johns
Hopkins University and an LHS II principal investigator,
"The bone loss was not clinically important. However, we
don't know whether it would progress with prolonged use of
the drug. Physicians treating patients with COPD should
weigh the benefits of inhaled corticosteroids against the
potential risks."
Participating LHS clinical centers are: Case Western
Reserve University, Cleveland, OH; Henry Ford Hospital,
Detroit, MI; Johns Hopkins University, Baltimore,
MD; Mayo Foundation, Rochester, MN; Oregon Health Sciences
University, Portland; University of Alabama, Birmingham;
University of California, Los Angeles; University of
Minnesota, Minneapolis; University of Pittsburgh,
Pittsburgh, PA; University of Utah, Salt Lake City; and the
University of Manitoba, Winnipeg, Canada. The Data and
Coordinating Center is located in the Division of
Biostatistics, School of Public Health, University of
Minnesota.
The drug used in LHS II was donated by Aventis, Inc.,
headquartered in Parsippany, NJ. The NHLBI is part of the
National Institutes of Health, located in Bethesda, MD.
For more information, contact the NHLBI Communications
Office at (301) 496-4236.
NHLBI press releases, scientific resources, and other
materials are online at www.nhlbi.nih.gov.
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