Chronic obstructive pulmonary disease (COPD) that is characterized by an inflammatory response to inhaled fumes such as tobacco smoke leading to shortness of breath, limited airflow, and loss of lung function is one of the five leading causes of death worldwide.

An inhaled steroid, Fluticasone propionate, could possibly reduce the ability of major pathogens to invade the respiratory epithelium, according to a study by Sebastian Albertí (Institut Universitari d’Investigacions en Ciències de la Salut, IUNICS, Palma de Mallorca, Spain) and colleagues.

From Medicalnewstoday.com:

Patients affected by COPD often suffer episodes of worsening of symptoms called acute exacerbations, mostly caused by bacterial infections. These episodes of exacerbation impact negatively on the health status of the patients, worsen their prognosis and are associated with a very significant social and economic cost.

Treatment with inhaled steroids, such as fluticasone propionate, reduces the frequency and severity of acute exacerbations in patients with COPD, but their role in controlling bacterial infection is controversial.

In healthy subjects the lung is sterile, but in patients with COPD it is not and bacteria like S. pneumoniae and H. influenzae is frequently isolated.

The study findings are considered to have critical implications for worldwide physicians for treating patients with COPD.

A London-based study has suggested that exacerbations in COPD (chronic obstructive pulmonary disease) patients could be minimized by as much as thirty-five percent when macrolide antibiotic is used in the long run.

Intervention can reduce the frequency and severity of COPD exacerbations highlighting considerable public health implications, according to John Heffner, M.D., past president of the ATS.

From News-Medical.Net:

The researchers found that not only did the patients randomized to receive erythromycin have fewer exacerbations, but among the patients studied, 60 percent of the exacerbations that occurred were within the placebo group. While the number of exacerbation-related hospitalizations was small, more than twice as many occurred among the placebo group—14 versus 6. The median duration of exacerbations from onset to resolution of symptoms was 9 days in the erythromycin group and 13 days in the placebo group.

“Our results did not allow us to determine a mechanism for these findings. However based on in-vitro studies we suspect that the mechanism is likely to involve the anti-inflammatory properties of erythromycin,” noted Dr. Seemungal.

While their findings are encouraging, Dr. Seemungal points out that they must be put in context with future findings. Furthermore, the threat of growing antibiotic resistance resulting from widespread prophylactic use of erythromycin is not a trivial concern. “In this scenario, substantial, widespread emergence of macrolide bacterial resistance is virtually foreordained, with attendant reduction in the antimicrobial usefulness of this drug class,” wrote Ken M. Kunisaki, M.D. and Denise E. Niewoehner, M.D., of the Veterans Affairs Medical Center in Minneapolis, in the accompanying editorial. “Balancing benefit against harm could pose a dilemma for which there might be no clear answers.”

As per lead author of the paper, Terence A. R. Seemungal, Ph.D., and Jadwiga Wedzicha, M.D., principle investigator, this study revealed that low doses of macrolide therapy were effective in reducing frequency of exacerbations and severity with moderate to severe COPD.

The frequency of exacerbations in patients with moderate to severe chronic obstructive pulmonary disease (COPD) may be reduced by as much as 35 percent with the use of a macrolide antibiotic in the long term, as per a London-based study.

It was remarked by lead author of the paper, Terence A. R. Seemungal, Ph.D., and Jadwiga Wedzicha, M.D., principle investigator that the study results suggest a significant impact of low-dose macrolide therapy, minimizing frequency of exacerbation, and severity with moderate to severe COPD.

From News-Medical.Net:

While their findings are encouraging, Dr. Seemungal points out that they must be put in context with future findings. Furthermore, the threat of growing antibiotic resistance resulting from widespread prophylactic use of erythromycin is not a trivial concern. “In this scenario, substantial, widespread emergence of macrolide bacterial resistance is virtually foreordained, with attendant reduction in the antimicrobial usefulness of this drug class,” wrote Ken M. Kunisaki, M.D. and Denise E. Niewoehner, M.D., of the Veterans Affairs Medical Center in Minneapolis, in the accompanying editorial. “Balancing benefit against harm could pose a dilemma for which there might be no clear answers.”

Moreover, not all of the study patients were treated with guideline-recommended therapy, such as inhaled corticosteroids or inhaled long-acting bronchodilators, which have been shown to decrease exacerbation frequency. The degree of added benefit of erythromycin over and above standard therapy will require further study.

“Observations that any intervention might decrease the frequency and severity of acute exacerbations in COPD present considerable public health implications,” observed John Heffner, M.D., past president of the ATS. “Exacerbations occur about once a year among patients with moderate to severe COPD and account for more than $30 billion dollars in direct and indirect costs annually in the United States alone.”

The results of this study were published in the first issue for December of the American Journal of Respiratory and Critical Care Medicine, which is published by the American Thoracic Society.

According to Lung disease experts at Johns Hopkins, medical practitioners must observe a high sense of care before recommending corticosteroids to patients suffering from COPD (chronic obstructive pulmonary disease).

It is believed that COPD is a complication affecting more than 11 million people in the United States alone and a big part of this affected population belongs to the category of past or present-day smokers.

From News-Medical.Net:

Despite the increased pneumonia risk, the team found no clear evidence that the drug therapy also pushes up rates for other steroid-related problems, such as bone fractures, nor was there an increase in deaths.

Senior study investigator and critical care specialist Eddy Fan, M.D., says the results of the analysis should not alarm patients or cause them to stop taking their medications but should spur physicians to screen and monitor their patients to find the lowest possible steroid dose that works, especially in the elderly, people with immune system problems, and people who have had multiple bouts of pneumonia and for whom repeat bacterial infection might be a life-threatening complication.

“Inhaled corticosteroids are not of equal benefit to all, and what we are seeing is that the treatment may be more harmful and pose a greater risk of harm to some,” says Fan, an instructor at the Johns Hopkins University School of Medicine.

Lead author and pulmonologist M. Brad Drummond, M.D., M.H.S., said the finding is nothing but a reminder for prevention of pneumonia, which can double the risk of death.

Patients suffering from chronic obstructive pulmonary disease (COPD) and administered with inhaled corticosteroids are at a lesser risk of mortality than COPD patients untreated with steroids.

This finding was noted in a new study that was published in an issue of CHEST, the peer-reviewed journal of the American College of Chest Physicians (ACCP).

The involved researchers noted that COPD patients on corticosteroids within 30 days from hospital discharge displayed a 25 percent reduced all-cause mortality rate and those using steroids paired with beta-agonists displayed a fall in cardiovascular-related deaths by 38 percent.

From News-Medical.Net:

Researchers also found a 23 percent reduced risk of death when comparing the effects of inhaled steroids with bronchodilators in patients in the 65+ group. In all cases, the most significant results were found when inhaled corticosteroids were administered within the first 30 days following hospital discharge.

“Our results indicate that the effect of inhaled corticosteroids is relatively short-term and that those currently using it are relatively better protected, ” said Dr. Macie. “Inhaled corticosteroids should be prescribed as soon as clinically indicated. By treating COPD with inhaled corticosteroids, we have the potential to reduce the effect and prolong life.”

“The findings from this study are intriguing for clinicians and point to the need for further research to define the role and mechanisms of the effect of inhaled corticosteroids on both cardiovascular and respiratory mortality,” said W. Michael Alberts, MD, FCCP, President of the ACCP.

Author Christine Macie, MD, FCCP, Cambridge Hospital, Ontario, Canada, remarked that COPD often remains an underrated lung ailment that has associated lung disease.

Researchers found that taking inhaled corticosteroids may lower the risk of lung cancer among people with chronic obstructive pulmonary disease (COPD). Inhaled corticosteroids reduce inflammation in the airways thereby improving symptoms associated with the disease.

Previous studies have shown that inhaled corticosteroids reduce markers of inflammation such as C-reactive protein and reduce airway inflammation.

From Bio-Medicine:

The study conducted by the University of Washington suggests people who took at least 1,200 micrograms per day of inhaled corticosteroids had a 61% lower risk of developing lung cancer than non-users.

Researchers followed a group of more than 10,000 mostly older male U.S. veterans with COPD who were treated in Veterans Affairs primary care clinics from 1996 to 2001. Of these, 517 were regular users of inhaled corticosteroids as determined by records of pharmacy refills and were included in the study’s analysis.

The results, published in the American Journal of Respiratory and Critical Medicine, suggested that compared with non-users of corticosteroids, those who took 1,200 micrograms or more per day of inhaled corticosteroids were 61% less likely to develop lung cancer.

The researchers note that this is an observational study that “cannot conclude that [inhaled corticosteroids] reduce lung cancer” and that the results need confirmation. They also say no drugs have been clinically proven to prevent lung cancer among those at risk, but several are under investigation.

Researchers said inflammation in the lungs is thought to play an important role in both COPD and lung cancer, and the results suggest that daily use of inhaled corticosteroids may help fight inflammation and prevent the progression from COPD to lung cancer.

Smoking is a primary cause of COPD, which includes two inflammatory lung diseases that interfere with breathing: chronic bronchitis and emphysema. An estimated 11 million adults suffer from COPD which could lead to lung cancer.

Inhaled corticosteroids are proven safe on bones. This was the finding of Jordana Schmier and his colleagues in their review of more than 260 studies. The group reviewed both published and unpublished literature and selected 14 studies that met their criteria. Majority of the studies reviewed included patients who received moderate to high doses of corticosteroid therapy.

From Bio-Medicine:

Previous studies have shown inhaled corticosteroids can decrease a person’s bone mineral density. However, researchers now say long-term use of ICS therapy is not associated with a significant change in BMD.

Corticosteroids are commonly used to treat asthmatics and people with chronic obstructive pulmonary disorder. Researchers say these medications are good at reducing inflammation and mucus production in the airways of the lungs.

Jordana Schmier and colleagues examined more than 260 studies and presented their findings at the Annual Scientific Assembly of the American College of CHEST Physicians in Orlando, Fla. They reviewed both published and unpublished literature and selected 14 studies that met their criteria. Researchers say the majority of the studies reviewed included patients who received moderate to high doses of corticosteroid therapy.

Results show long-term use of these medications by patients with asthma or COPD was not associated with significant changes in BMD. Schmier says using ICS therapy is important in controlling symptoms of various lung disorders. She concluded, “ICS treatment at standard doses in patients with asthma or COPD does not have a clinically meaningful effect on BMD.”

The researchers claim that inhaled corticosteroids do not cause significant effects on bone mineral density (BMD) of the patients. This conclusion was contrary to the findings of the previous studies which linked corticosteroids to bone loss.

Corticosteroids are prescribed to asthmatic patients and people with chronic obstructive pulmonary disorder (COPD) because these drugs reduce inflammation and mucus production in the airways of the lungs.