TABLE 2.
BENEFICIAL EFFECTS OF SYSTEMIC AND INHALED CORTICOSTEROID THERAPY IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE
| Systemic Corticosteroid (Reference) | Inhaled Corticosteroid (Reference) | |
|---|---|---|
| Lung | Reduced MP levels in sputum (36) | Reduced oxidative stress (40) |
| Decreased eosinophils in sputum (37, 38) | Reduced mast cells (41) | |
| May reduce basal release of GM-CSF by alveolar macrophages (39) | May down-regulate production and/or release of IL-6 and IL-8 from bronchial epithelial cells (42) | |
| Blood | Reduced CRP levels (43) | |
| Clinical | Improved PFTs (52), shorter hospitalization (55), and reduced rate of treatment failure (55) in acute exacerbations | Reduced bronchial hyperreactivity (65) |
| Reduced exacerbations in moderate to severe COPD (59, 60, 67, 68, 72) | ||
| Slowed rate of decline in health status and QOL (59) | ||
| Improved pre-BD FEV1, oxygenation, and dyspnea (61) | ||
| Discontinuation of ICS may lead to increased exacerbation rates and worse QOL (62) | ||
| ICS + LABAs: improved pre-BD FEV1 (68–71) | ||
| Improvement in cough, sputum score, and reduced use of reliever medications (41) | ||
| May reduce mortality (69, 73–80) | ||
| May improve post-BD FEV1 during acute exacerbations (89) |
Definition of abbreviations: BD = bronchodilator; COPD = chronic obstructive pulmonary disease; CRP = C-reactive protein; GM-CSF = granulocyte-macrophage colony–stimulating factor; ICS = inhaled corticosteroids; LABAs = long-acting β-agonists; MP = myeloperoxidase; PFT = pulmonary function test; QOL = quality of life.