Inhaled steroids widely used to treat emphysema and other degenerative respiratory ailments do not slow the progression of the disease but can ease the symptoms during flare-ups, a government study found.
Steroids reduced urgent doctor’s visits, hospitalizations and airway sensitivity to cold and other irritants.
But long use caused two side effects: increased skin bruising and loss of bone density.
The study looked at chronic obstructive pulmonary disease, which includes chronic bronchitis and emphysema. It progressively reduces how much air the lungs can hold and is considered largely untreatable.
Doctors had hypothesized that inhaled steroids widely used for asthma might slow progression of chronic obstructive pulmonary disease by reducing airway inflammation. But the researchers found no significant difference in lung function decline.
One Fourth Fewer Flare-Ups
However, the patients who used steroids had about one-fourth fewer flare-ups of breathing difficulty, just over half as many doctor’s visits and less airway sensitivity to irritants.
The study was published in today’s New England Journal of Medicine.
About 560 patients with a moderate form of the disease took six puffs of medicine from an inhaler twice a day for more than three years. A comparison group inhaled a dummy solution.
Dr. Robert A. Wise, a pulmonary disease specialist at Johns Hopkins University who helped lead the study, said the findings mean that inhaled steroids still have a role in treating patients with frequent symptoms of the deadly lung disease. But he said they should be given calcium and vitamin D supplements.
“This is really going to be an individual decision between the patient and physician,” said Dr. Norman H. Edelman, dean of the medical school at the State University of New York at Stony Brook and a consultant to the American Lung Association.
About 16 million Americans have chronic obstructive pulmonary disease, the nation’s No. 4 cause of death and No. 2 cause of disability.
Inhaled steroids “are commonly prescribed for patients with COPD, although their effectiveness has not been consistently shown,” said Dr. Claude Lenfant, director of the National Heart, Lung and Blood Institute. The latest findings “provide us with the full picture of their benefits and risks.”
The institute funded the study. The steroid tested, Azmacort, was provided by manufacturer Aventis Pharma of Parsippany, N.J.
The patients used their medication only about 60 percent as frequently as directed. That is actually better than the average for members of the public with chronic health conditions.
“If there had been 100 percent compliance, maybe there would have been an effect on progression of the disease,” Edelman said.