Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Respiratory Research
Published in: Respiratory Research 1/2019

Open Access 01-12-2019 | Fluticasone | Review

Inhaled corticosteroids and FEV1 decline in chronic obstructive pulmonary disease: a systematic review

Authors: Hannah R. Whittaker, Debbie Jarvis, Mohamed R. Sheikh, Steven J. Kiddle, Jennifer K. Quint

Published in: Respiratory Research | Issue 1/2019

Login to get access

Abstract

Rate of FEV1 decline in COPD is heterogeneous and the extent to which inhaled corticosteroids (ICS) influence the rate of decline is unclear. The majority of previous reviews have investigated specific ICS and non-ICS inhalers and have consisted of randomised control trials (RCTs), which have specific inclusion and exclusion criteria and short follow up times. We aimed to investigate the association between change in FEV1 and ICS-containing medications in COPD patients over longer follow up times.
MEDLINE and EMBASE were searched and literature comparing change in FEV1 in COPD patients taking ICS-containing medications with patients taking non-ICS-containing medications were identified. Titles, abstract, and full texts were screened and information extracted using the PICO checklist. Risk of bias was assessed using the Cochrane Risk of Bias tool and a descriptive synthesis of the literature was carried out due to high heterogeneity of included studies.
Seventeen studies met our inclusion criteria. We found that the difference in change in FEV1 in people using ICS and non-ICS containing medications depended on the study follow-up time. Shorter follow-up studies (1 year or less) were more likely to report an increase in FEV1 from baseline in both patients on ICS and in patients on non-ICS-containing medications, with the majority of these studies showing a greater increase in FEV1 in patients on ICS-containing medications. Longer follow-up studies (greater than 1 year) were more likely to report a decline in FEV1 from baseline in patients on ICS and in patients on non-ICS containing medications but rates of FEV1 decline were similar.
Further studies are needed to better understand changes in FEV1 when ICS-containing medications are prescribed and to determine whether ICS-containing medications influence rate of decline in FEV1 in the long term. Results from inclusive trials and observational patient cohorts may provide information more generalisable to a population of COPD patients.
Appendix
Available only for authorised users
Literature
1.
2.
3.
4.
5.
6.
Vestbo J, Anderson JA, Brook RD, Calverley PMA, Celli BR, Crim C, et al. Fluticasone furoate and vilanterol and survival in chronic obstructive pulmonary disease with heightened cardiovascular risk (SUMMIT): a double-blind randomised controlled trial. Lancet. 2016;387(10030):1817–26.PubMedCrossRef
7.
Sutherland ER, Allmers H, Ayas NT, Venn AJ, Martin RJ. Inhaled corticosteroids reduce the progression of airflow limitation in chronic obstructive pulmonary disease: a metaanalysis. Thorax. 2003;58:937–41.PubMedPubMedCentralCrossRef
8.
Lapperre TS, Snoeck-Stroband JB, Gosman MME, Jansen DF, van Schadewljk A, Thladens HA, et al. Effect of fluticasone with and without Salmeterol on pulmonary outcomes in chronic obstructive pulmonary disease. Ann Intern Med. 2009;151:517–27.PubMedCrossRef
9.
Calverley PM, Anderson JA, Brook RD, Crim C, Gallot N, Kilbride S, et al. Fluticasone furoate, vilanterol and lung function decline in patients with moderate COPD and heightened cardiovascular risk. Am J Respir Crit Care Med. 2017;197(1):47-55.
10.
Vestbo J, Edwards LD, Scanlon PD, Yates JC, Agusti A, Bakke P, et al. Changes in forced expiratory volume in 1 second over time in COPD. N Engl J Med. 2011;365(13):1184–92.PubMedCrossRef
11.
Tashkin DP. Variations in FEV (1) decline over time in chronic obstructive pulmonary disease and its implications. Curr Opin Pulm Med. 2013;19(2):116–24.PubMedCrossRef
12.
Woodcock A, Boucot I, Leather DA, Crawford J, Collier S, Bakerly ND, et al. Effectiveness versus efficacy trials in COPD: how study design influences outcomes and applicability. Eur Respir J. 2018;51(2):1701531.CrossRef
13.
Rodrigo GJ, Price D, Anzueto A, Singh D, Altman P, Bader G, et al. LABA/LAMA combinations versus LAMA monotherapy or LABA/ICS in COPD: a systematic review and meta-analysis. Int J Chron Obstruct Pulmon Dis. 2017;12:907–22.PubMedPubMedCentralCrossRef
14.
Rogliani P, Calzetta L, Braido F, Cazzola M, Clini E, Pelaia G, et al. LABA/LAMA fixed-dose combinations in patients with COPD: a systematic review. Int J Chron Obstruct Pulmon Dis. 2018;13:3115–30.PubMedPubMedCentralCrossRef
15.
Miravitlles M, Urrutia G, Mathioudakis AG, Ancochea J. Efficacy and safety of tiotropium and olodaterol in COPD: a systematic review and meta-analysis. Respir Res. 2017;18(1):196.PubMedPubMedCentralCrossRef
16.
Horita N, Miyazawa N, Tomaru K, Inoue M, Kaneko T. Long-acting muscarinic antagonist+long-acting beta agonist versus long-acting beta agonist+inhaled corticosteroid for COPD: A systematic review and meta-analysis. Respirology (Carlton, Vic). 2015;20(8):1153–9.CrossRef
17.
Rodrigo GJ, Castro-Rodriguez JA, Plaza V. Safety and efficacy of combined long-acting beta-agonists and inhaled corticosteroids vs long-acting beta-agonists monotherapy for stable COPD: a systematic review. Chest. 2009;136(4):1029–38.PubMedCrossRef
18.
Van Grunsven PM, Van Schayck CP, Derenna JP, Kerstjens HAM, Renkema TEJ, Postma DS, et al. Long term effects of inhaled corticosteroids in chronic obstructive pulmonary disease: a meta-analysis. Thorax. 1999;54:7–14.PubMedPubMedCentralCrossRef
19.
Higgins JP, Altman DG, Gotzsche PC, Juni P, Moher D, Oxman AD, et al. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ. 2011;343:d5928.PubMedPubMedCentralCrossRef
20.
Altman DG. Practical statistics for medical research. London: Chapman and Hall; 1991.
21.
Auffarth B, Postma DS, De Monchy JGR, Van Der Mark TW, Boorsma M, Koeter GH. Effects of inhaled budesonide on spirometric values, reversibility, airway responsiveness, and cough threshold in smokers with chronic obstructive lung disease. Thorax. 1991;46(5):372–7.PubMedPubMedCentralCrossRef
22.
Cazzola M, Di Lorenzo G, Di Perna F, Calderaro F, Testi R, Centanni S. Additive effects of salmeterol and fluticasone or theophylline in COPD. Chest. 2000;118(6):1576–81.PubMedCrossRef
23.
Lee SD, Xie CM, Yunus F, Itoh Y, Ling X, Yu WC, et al. Efficacy and tolerability of budesonide/formoterol added to tiotropium compared with tiotropium alone in patients with severe or very severe COPD: a randomized, multicentre study in East Asia. Respirology. 2016;21(1):119–27.PubMedCrossRef
24.
Bourbeau J, Rouleau MY, Boucher S. Randomised controlled trial of inhaled corticosteroids in patients with chronic obstructive pulmonary disease. Thorax. 1998;53(6):477–82.PubMedPubMedCentralCrossRef
25.
Ohar JA, Crater GD, Emmett A, Ferro TJ, Morris AN, Raphiou I, et al. Fluticasone propionate/salmeterol 250/50 mug versus salmeterol 50 mug after chronic obstructive pulmonary disease exacerbation. Respir Res. 2014;15:105.PubMedPubMedCentralCrossRef
26.
Vestbo J, Pauwels R, Anderson JA, Jones P, Calverley P. Early onset of effect of salmeterol and fluticasone propionate in chronic obstructive pulmonary disease. Thorax. 2005;60(4):301–4.PubMedPubMedCentralCrossRef
27.
Vestbo J, Papi A, Corradi M, Blazhko V, Montagna I, Francisco C, et al. Single inhaler extrafine triple therapy versus long-acting muscarinic antagonist therapy for chronic obstructive pulmonary disease (TRINITY): a double-blind, parallel group, randomised controlled trial. Lancet (London, England). 2017;389(10082):1919–29.CrossRef
28.
Wise R, Connett J, Weinmann G, Scanlon P, Skeans M. Effect of inhaled triamcinolone on the decline in pulmonary function in chronic obstructive pulmonary disease. N Engl J Med. 2000;343(26 I):1902–9.PubMed
29.
Weir DC, Bale GA, Bright P, Sherwood BP. A double-blind placebo-controlled study of the effect of inhaled beclomethasone dipropionate for 2 years in patients with nonasthmatic chronic obstructive pulmonary disease. Clin Exp Allergy. 1999;29(Suppl 2):125–8.PubMedCrossRef
30.
Renkema TEJ, Schouten JP, Koeter GH, Postma DS. Effects of long-term treatment with corticosteroids in COPD. Chest. 1996;109(5):1156–62.PubMedCrossRef
31.
Burge PS, Calverley PMA, 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. Br Med J. 2000;320(7245):1297–303.CrossRef
32.
Calverley PMA, Spencer S, Willits L, Burge PS, Jones PW. Withdrawal from treatment as an outcome in the ISOLDE study of COPD. Chest. 2003;124(4):1350–6.PubMedCrossRef
33.
Pauwels RA, Lofdahl CG, Laitinen LA, Schouten JP, Postma DS, Pride NB, et al. Long-term treatment with inhaled budesonide in persons with mild chronic obstructive pulmonary disease who continue smoking. European Respiratory Society study on chronic obstructive pulmonary disease. N Engl J Med. 1999;340(25):1948–53.PubMedCrossRef
34.
Vestbo J, Sorensen T, Lange P, Brix A, Tone P, Viskum K. Long-term effect of inhaled budesonide in mild and moderate chronic obstructive pulmonary disease: a randomised controlled trial. Lancet. 1999;353(9167):1819–23.PubMedCrossRef
35.
Calverley PMA, Anderson JA, Brook RD, Crim C, Gallot N, Kilbride S, et al. Fluticasone furoate, vilanterol, and lung function decline in patients with moderate chronic obstructive pulmonary disease and heightened cardiovascular risk. Am J Respir Crit Care Med. 2018;197(1):47–55.PubMedCrossRef
36.
Shaker SB, Dirksen A, Ulrik CS, Hestad M, Stavngaard T, Laursen LC, et al. The effect of inhaled corticosteroids on the development of emphysema in smokers assessed by annual computed tomography. COPD. 2009;6(2):104–11.PubMedCrossRef
37.
Babu KS, Kastelik JA, Morjaria JB. Inhaled corticosteroids in chronic obstructive pulmonary disease: a pro-con perspective. Br J Clin Pharmacol. 2014;78(2):282–300.PubMedPubMedCentralCrossRef
38.
Calverley PMA, Anderson JA, Celli B, Ferguson GT, Jenkins C, Jones PW, et al. Salmeterol and fluticasone propionate and survival in chronic obstructive pulmonary disease. N Engl J Med. 2007;356(8):775–89.PubMedCrossRef
39.
Barnes PJ, Shapiro SD, Pauwels RA. Chronic obstructive pulmonary disease: molecular and cellularmechanisms. Eur Respir J. 2003;22(4):672.PubMedCrossRef
40.
Barnes PJ. Immunology of asthma and chronic obstructive pulmonary disease. Nat Rev Immunol. 2008;8(3):183–92.PubMedCrossRef
41.
Usmani OS, Ito K, Maneechotesuwan K, Ito M, Johnson M, Barnes PJ, et al. Glucocorticoid receptor nuclear translocation in airway cells after inhaled combination therapy. Am J Respir Crit Care Med. 2005;172(6):704–12.PubMedCrossRef
42.
Barnes PJ. Scientific rationale for inhaled combination therapy with long-acting β<sub>2</sub>-agonists and corticosteroids. Eur Respir J. 2002;19(1):182.PubMedCrossRef
43.
44.
Lal C, Strange C. A review of current and developing fixed-dose LABA/LAMA combinations for treating COPD. Expert Opin Pharmacother. 2017;18(17):1833–43.PubMedCrossRef
45.
Rogliani P, Braido F, Calzetta L, Cazzola M, Clini EM, Pelaia G, et al. Lama/laba fixed combinations for COPD management: A systematic comparative review. American Journal of Respiratory and Critical Care Medicine Conference: American Thoracic Society International Conference, ATS. 2018;197(MeetingAbstracts).
46.
Barnes NC, Sharma R, Lettis S, Calverley PM. Blood eosinophils as a marker of response to inhaled corticosteroids in COPD. Eur Respir J. 2016;47(5):1374–82.PubMedCrossRef
47.
Whittaker HR, Mullerova H, Jarvis D, Barnes NC, Jones PW, Compton CH, et al. Inhaled corticosteroids, blood eosinophils, and FEV1 decline in patients with COPD in a large UK primary health care setting. Int J Chron Obstruct Pulmon Dis. 2019;14:1063–73.PubMedPubMedCentralCrossRef
48.
49.
Suissa S, Patenaude V, Lapi F, Ernst P. Inhaled corticosteroids in COPD and the risk of serious pneumonia. Thorax. 2013;68(11):1029–36.PubMedCrossRef
50.
Janson C, Johansson G, Stallberg B, Lisspers K, Olsson P, Keininger D, et al. ICS and risk of pneumonia in Swedish COPD patients: The ARCTIC study. Eur Respir J. 2016;48:PA3946.
51.
Park HY, Man SF, Sin DD. Inhaled corticosteroids for chronic obstructive pulmonary disease. BMJ. 2012;345:e6843.PubMedCrossRef
52.
Gruffydd-Jones K, Brusselle G, Jones R, Miravitlles M, Baldwin M, Stewart R, et al. Changes in initial COPD treatment choice over time and factors influencing prescribing decisions in UK primary care: in UK primary care: a real-world, retrospective, observational. NPJ Prim Care Respir Med. 2016;26:16002.PubMedPubMedCentralCrossRef
53.
Jones PW, Beeh KM, Chapman KR, Decramer M, Mahler DA, Wedzicha JA. Minimal clinically important differences in pharmacological trials. Am J Respir Crit Care Med. 2014;189(3):250–5.PubMedCrossRef
54.
Metadata
Title
Inhaled corticosteroids and FEV1 decline in chronic obstructive pulmonary disease: a systematic review
Authors
Hannah R. Whittaker
Debbie Jarvis
Mohamed R. Sheikh
Steven J. Kiddle
Jennifer K. Quint
Publication date
01-12-2019
Publisher
BioMed Central
Published in
Respiratory Research / Issue 1/2019
Electronic ISSN: 1465-993X
DOI
https://doi.org/10.1186/s12931-019-1249-x

Other articles of this Issue 1/2019

Respiratory Research 1/2019 Go to the issue

Research

YY1 mediates TGF-β1-induced EMT and pro-fibrogenesis in alveolar epithelial cells

Review

Breath biomarkers in idiopathic pulmonary fibrosis: a systematic review

Research

Circulating ESM-1 levels are correlated with the presence of coronary artery disease in patients with obstructive sleep apnea

Research

Chronic obstructive pulmonary disease upper airway microbiota alpha diversity is associated with exacerbation phenotype: a case-control observational study

Research

DSP variants may be associated with longitudinal change in quantitative emphysema

Research

The biomarkers suPAR and blood eosinophils are associated with hospital readmissions and mortality in asthma – a retrospective cohort study
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

Read more

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine
Image Credits