Efficacy and safety of inhaler steroids in COPD patients: Systematic review and meta-analysis of randomized placebo-controlled trials

BACKGROUND Chronic obstructive pulmonary disease (COPD) is a major health dilemma and cause of morbidity and mortality in either industrialized or developing countries and inhaled corticosteroids are widely used worldwide in these patients. In this systematic review, we aimed to analyze the effectiveness of these gents compared to placebo. METHODS Pubmed and Google Scholar literature search has been done to find randomized placebo-controlled trials investigating effectiveness of inhaled steroids in COPD patients. Finally, the data from 18 trials had been retrieved and included into a database, and analyzed using Stata ® v.9.0. RESULTS Data of 12, 297 COPD subjects were analyzed. Analysis of survival of patients in the two groups showed no significant difference between those taking inhaled corticosteroids or placebo (relative risk (RR): 1.071, 95% confidence interval (CI): 0.938-1.224, P=0.309). Patients taking inhaled steroids were significantly less likely to develop an exacerbation episode (RR: 0.697, 95%CI: 0.596-0.816, p<0.001) or to have less withdrawal rate than placebo (RR: 0.882, 95%CI: 0.811-0.960; P=0.004). CONCLUSION Because steroid inhalers represent no survival effects in COPD patients, and due to their life threatening side effects (pneumonia, candidemia, etc.), we propose to replace steroid inhalers to cheaper agents which provide patients with comparable advantages (e.g. few exacerbations) and fewer side effects. Pulmonary rehabilitations as well as anti-inflammatory drugs are recommended to be more attended in COPD patients.