ABSTRACT
Chronic obstructive pulmonary disease (COPD) is a serious condition characterized by
symptoms, particularly breathlessness, that range from the troublesome to the disabling
in symptomatic patients with more than mild disease. Episodic exacerbations of these
symptoms are commonly reported and contribute to a worsening health status (1) as
well as predicting the risk of premature death (2). Lung function decline is accelerated
when compared with that seen in older normal individuals free from COPD and has
become an accepted marker of disease progression (3). Given these problems, it is not
surprising that doctors are prepared to consider all available treatments that might offer
the chance of reducing the morbidity associated with this disease, especially when the
treatment in question has been highly effective in a related condition like bronchial
asthma. Although the data available until quite recently were relatively limited, the
use of corticosteroids in the management of COPD has been widespread and has
normally occurred despite the lack of specific regulatory approval for these drugs in this
condition. Glucocorticosteroids have been used in quite varying ways ranging from
high-dose oral treatment given to stable people as a diagnostic test, through oral or
systemic treatment of exacerbations to low-dose oral or inhaled corticosteroids (ICSs)
in the management of stable disease. More recently, ICSs have been available in
combination with long-acting b-agonists (LABAs) and these are now commonly given
in single inhalers.
