The benefits of chronic corticosteroid use in patients with chronic obstructive pulmonary disease (COPD) are not well-established. Compared with patients who have asthma, patients with COPD have unclear benefits from corticosteroids. Nevertheless, many patients with COPD are labeled “steroid-dependent” and continue taking chronic doses of oral or inhaled corticosteroids. Few randomized trials have been conducted to determine the additional benefit of this therapy in patients with COPD. Rice and colleagues performed a double-blind, placebo-controlled trial of 38 patients with “steroid-dependent” COPD to determine the effect of withdrawing systemic corticosteroid therapy in patients on “maintenance” low-dose therapy.
Eligible subjects included those who met the American Thoracic Society criteria of COPD. All had been taking prednisone at a daily dosage of at least 5 mg per day for the preceding six months. Excluded were those with a clinical diagnosis of asthma, a strong family history of atopy or a concomitant major illness. All subjects also received inhaled triamcinolone acetonide. Patients were randomly assigned to receive their usual maintenance dose of prednisone for six months or to be withdrawn from prednisone at a rate of 5 mg per week.
Study results revealed that the number of COPD exacerbations per patient was similar (2.5 to 2.7). Spirometric results, dyspnea and health-related quality of life indicators did not differ significantly between the two groups. Weight decreased in the demand group by 4.8 kg, compared with a 0.5 kg increase in the continuous group.
The authors concluded that withdrawal of chronic low-dose systemic steroids did not adversely affect COPD–related outcomes. Furthermore, steroid-associated complications, such as weight gain, were affected by withdrawal of this agent.
editor's note: Family physicians caring for patients with COPD who are taking chronic low-dose systemic corticosteroids should consider the slow discontinuation of this medication and instead make use of demand dosing. It is likely that this change will not adversely affect the management of the disease. Furthermore, patients are likely to experience quality-of-life benefits from discontinuing oral corticosteroid therapy, including reduced body weight.—j.n.