Corticosteroids: clinical use
Chronic obstructive pulmonary disease (COPD) is now defined not only by the presence of persistent airflow obstruction but by its association with chronic inflammation within the lungs , a finding now confirmed in a large series of lung resection specimens . It is no surprise then that corticosteroids, our most successful anti-inflammatory therapy, have been used to treat COPD patients. These drugs have proven very valuable in the management of bronchial asthma, so successful in fact that some clinicians seem to believe that any COPD patient responding to corticosteroid treatment could not have had COPD in the first place but must really have been an asthmatic-no matter how typical the clinical presentation might have been! This redefinition of ‘asthma’ in COPD by the response to a specific therapy, although neither officially accepted nor intellectually sustainable, has become a shorthand way of making clinical decisions. It is an approach that makes the rational use of corticosteroids in COPD particularly difficult and despite its seductive simplicity it should be resisted.