Corticosteroid therapy in non-asthmatic chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is a common condition. Medical , and particularly drug, therapy still provides insufficiently effective re lief. Corticosteroid treatment relies on the effect of these drugs on the u nderlying inflammatory mechanisms. Their efficacy has been demonstrated in asthma which exhibits certain features common with COPD. I Indications: Short-term corticosteroid regimens are generally well tolerate d. Clinical data favor their use in certain cases of acute decompensation. Long-term systemic regimens are not warranted due to the risk of adverse ef fects and the difficulty in maintaining appropriate dosages. Inhaled cortic osteroids are widely used although the efficacy remains controversial. Important drawbacks: Clear evidence of efficacy from large controlled trial s is still lacking. The difficulty encountered in obtaining such evidence i s an indication of the minimal impact of such treatment and raises the ques tion of its clinical pertinence. Patients exhibiting features similar to th ose observed in asthma (atopy, eosinophilia, improvement with bronchodilata tion, non-smokers...) should be able to benefit from corticosteroids. For o thers a therapeutic test would be advisable to identify responders who coul d benefit from a preventive effect on the progression of COPD or associated asthma. A test lasting a few weeks at sufficient dosage is needed for subj ective and objective (respiratory function tests) assessment. This costly t herapy would not be warranted in nonresponders, particularly in light of th e expected secondary effects. Current evidence does not point to corticoste roid therapy as the much needed fully effective treatment for COPD.