Steroids in COPD Management

Steroids in COPD Management

(Dr. Guru Prasad Mohanta, Professor, Department of Pharmacy, Annamalai University, Annamalai Nagar – 608 002, Tamil Nadu, E. mail: gpmohanta@hotmail.com)

Chronic Obstructive Pulmonary Disease (COPD), a new terminology, is now widely accepted for emphysema or chronic bronchitis or both. COPD has become one of the major causes of morbidity and mortality. Worldwide more than 3 million people died due to COPD in 2005 which accounts to 5 % of all deaths globally in 2005. Though no reliable data is available, the various study reported the prevalence of COPD in India is slightly more than 4%. Being a chronic and progressive disease process, it causes a huge economic burden to the patients and the health system as well. Though the primary cause of COPD is tobacco smoke, the indoor and outdoor environmental pollution are also risk factors.

The common symptoms include breathlessness, coughing and phlegm. The acute condition with worsening of patients’ respiratory situation often requires hospitalization and medical intervention. In mild COPD, the shortness of breath may occur only with exertion.  The most common medicine interventions include the use of bronchodilator (s) and steroids. The bronchodilators widen the tubes of lungs and the steroid helps in controlling the underlying inflammation in the lungs. The inhaled bronchodilators improve symptoms, decrease exacerbations and improve quality of life. The inhaled and systemic steroids have beneficial effects in acute exacerbation of COPD. Though the present article is not intends to discuss the pros and cons of various treatment options, the following recent appeared evidences would serve as guide for promoting rational therapy:

·         A 7 to 14 days treatment with oral glucocorticoid (prednisone / prednisolone) is recommended for acute exacerbated COPD.  This is known to shorten the recovery time and hospitalization duration, improve lung function and blood oxygen levels, and reduces the risk of treatment failure and a recurrent exacerbation in short term. The recent study reports that a short five day course of glucocorticoid therapy for acute COPD exacerbation works equally as 14 days course for most patients. This finding enables the healthcare providers to minimize steroid exposure and reduce the steroid related harms in patients. Stopping the medicine is as important as starting it. The oral corticosteroids are ineffective and are not recommended in stable COPD.

·         The combined inhalation treatment with inhaled steroid and long acting beta agonist is often used. The combined treatment (Budesonide + Formoterol; Fluticasone + Salmeterol) is more effective than long acting beta agonist [LOBA] alone in improving health related quality of life.  The recent study showed that there is increased risk of pneumonia with combined inhalers from around 3 per 100 people per year on LOBA to 4 per 100 per year on combined inhalers. Approximately every 17 people treated with combined inhaler, one extra person may get pneumonia (compared to placebo). There is also increased risk of candidiasis. Guiding the patients on appropriate use of inhalers and instructing to wash the mouth after each inhalation would reduce the chances of fungal infection.