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SUPPLEMENT: Peter J. Barnes Mechanisms in COPD : Differences From Asthma Chest 2000; 117: 10S-14S [Abstract] [Full text] [PDF]

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Mechanisms in COPD : Should corticosteroids be given in COPD ?

S K Agarwal   (9 February 2001)

Mechanisms in COPD : Should corticosteroids be given in COPD ? 9 February 2001
S K Agarwal, Head, Department of Chest Diseases, Institute of Medical Sciences, BHU, India Send letter to journal: Re: Mechanisms in COPD : Should corticosteroids be given in COPD ? sk_agarwal{at}satyam.net.in S K Agarwal	There is ample evidence that inhaled corticosteroids improve lung function and symptoms, enhance quality of life and prevent allergen- induced bronchoconstriction in asthma. The pathophysiology in COPD is different with a predominance of CD8 cells, increased neutrophils, and no evidence of thickening of the basement membrane or disruption of the airway epithelium [1]. Why inhaled corticosteroids have been adopted in the long-term management of COPD is really puzzling. In part this may be due to the diagnostic overlap and confusion between asthma and COPD, especially in the elderly patient, since the symptoms of both disorders are very similar. The inflammatory mediators involved in COPD are less well defined than those in asthma [2]. The concentration of leukotreine B4, which is chemotactic for neutrophils, is increased in the sputum of patients with COPD. Concentrations of the cytokines TNF-alpha and the neutrophil- chemotactic chemokine interleukin-8 are also increased in the sputum of patients with COPD. It’s now very well clear that long-term treatment with high doses of inhaled corticosteroids do not reduce the progression of COPD, even when the treatment is started before the disease becomes symptomatic. It’s quite common in India to see almost all COPD patients receiving either or oral steroids for several years. References: 1. Buist,AS. Do bronchodilators or steroid have any effect on the decline in lung function in COPD? Eur Resp Rew 2000; 10:75,465-469 2. Barnes,PJ. Medical progress : COPD The New Eng J of Med 2000; 343, 269-280