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Corticosteroids

Oral or inhaled corticosteroids, on account of their anti-inflammatory properties, may be useful in ascertaining the maximum achievable level of FEV1 in a patient (ref. 1).

Effective treatment with corticosteroids improves the level of FEV1, and this affects the response to shortacting bronchodilators (view experimental data in the animation). It also attenuates the maximal airway narrowing that may occur on exposure to bronchoconstricting agents, so that anti-inflammatory treatment diminishes the risk of lifethreatening bronchoconstriction (ref. 2).

In patients with COPD corticosteroids improve the post-bronchodilator FEV1 and bronchial responsiveness to a small extent. Also there is a some reduction in the number of exacerbations and in quality of life, but no effect on the rate of change of FEV1 (ref.3).


Ref. 1 - Variability in bronchodilator responsiveness within subjects
  Kerstjens HAM, Brand PLP, Quanjer PhH, van der Bruggen-Bogaerts BAHA, Koëter GH, Postma DS, and the Dutch CNSLD Study Group. Variability of bronchodilator response and effects of inhaled corticosteroid treatment in obstructive airways disease. Thorax 1993; 48: 722-729.
 
Ref. 2 - Attenuated bronchoconstrictor response
  Bel EH, Timmers MC, Dijkman JH, Sterk PJ. The effect of inhaled corticosteroids on the maximal degree of airway narrowing to methacholine in asthmatic subjects. Am Rev Respir Dis 1991; 143: 109-111.
 
Ref. 3 - Glucocorticosteroids and COPD
  Burge PS, Calverley PM, Jones PW, Spencer S, Anderson JA, Maslen TK. Randomised, double blind, placebo controlled study of fluticasone propionate in patients with moderate to severe chronic obstructive pulmonary disease: the ISOLDE trial. BMJ 2000; 320: 1297–1303.
  Pauwels RA, Lofdahl C-G, Laitinen LA, et al. Long-term treatment with inhaled budesonide in persons with mild chronic obstructive pulmonary disease who continue smoking. New Engl J Med 1999; 340: 1948–1953.
  The Lung Health Study Research Group. Effect of inhaled triamcinolone on the decline in pulmonary function in chronic obstructive pulmonary disease. New Engl J Med 2000; 343: 1902–1909.
  Vestbo J, Sorensen T, Lange P, Brix A, Torre P, Viskum K. Long-term effect of inhaled budesonide in mild and moderate chronic obstructive pulmonary disease: A randomised controlled trial. Lancet 1999; 353: 1819–1823.
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