A comparative study to evaluate the role of inhaled steroid versus low-dose oral steroid in patients of chronic obstructive pulmonary disease

Authors

  • Surya Kant Department of Pulmonary Medicine, King George’s Medical University, Lucknow, Uttar Pradesh, India
  • Jawed Ahmad Department of Pulmonary Medicine, Vivekanand Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
  • Mohammed Javed Siddiqui Department of Pulmonary Medicine, Vivekanand Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
  • Arpita Singh Department of Pharmacology, GSVM Medical College, Kanpur, Uttar Pradesh, India
  • Ajay Kumar Verma Department of Pulmonary Medicine, King George’s Medical University, Lucknow, Uttar Pradesh, India
  • Ankit Bhatia Department of Pulmonary Medicine, King George’s Medical University, Lucknow, Uttar Pradesh, India

Keywords:

Chronic obstructive pulmonary disease, Corticosteroids, Forced expiratory volume in 1 sec, Exacerbation

Abstract

Background: Chronic obstructive pulmonary disease (COPD) is a leading cause of death and disability worldwide. Its prevalence is increasing globally, especially in countries with high frequencies of smoking combined with significant environmental exposures to pollutants and biomass smoke. Currently COPD is the third leading cause of death worldwide, after ischemic heart disease and stroke. Efforts have been made to design a standard protocol for treatment of the disease, and these efforts are still in the process.

Methods: The study was done on 100 subjects to assess whether steroid (inhaled or oral) actually have any role in decreasing the decline in forced expiratory volume in 1 sec and to compare the effect of both to find out which one is superior. Patients were divided into two arms, inhaled steroids group (according to GOLD guidelines), and the other group was oral prednisolone 10 mg in addition to standard treatment except inhaled steroid. The effects were studied with appropriate statistical tests.

Results: Our study data showed that oral steroids are more effective on symptom control as compared to inhaled steroids. Symptoms such as cough (64% vs. 82%) and breathlessness (76% vs. 94%) significantly improved in the oral corticosteroids group. The rate of exacerbation also improved (22% vs. 12%) in the test group.

Conclusion: The use of steroids has ever been a subject of divergence of views ever since its role in the treatment of COPD was first described. Although, overall steroid in any form is beneficial in symptomatic/subjective and objective improvements in COPD, oral steroids stand a better chance as compared to inhaled steroids.

References

Global Strategy for the Diagnosis, Management and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD), 2014. Available from: http://www.goldcopd.org/. Accessed 30 October 2014.

Divo M, Cote C, de Torres JP, Casanova C, Marin JM, Pinto Plata V, et al. Comorbidities and risk of mortality in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2012;186(2):155-61.

Shapiro SD, Ingenito EP. The pathogenesis of chronic obstructive pulmonary disease: advances in the past 100 years. Am J Respir Cell Mol Biol. 2005;32(5):367-72.

Hogg JC. Pathophysiology of airflow limitation in chronic obstructive pulmonary disease. Lancet. 2004;364(9435):709 21.

Frost RA, Lang CH, Gelato MC. Transient exposure of human myoblasts to tumor necrosis factor-alpha inhibits serum and insulin-like growth factor-I stimulated protein synthesis. Endocrinology. 1997;138(10):4153-9.

Debigaré R, Marquis K, Côté CH, Tremblay RR, Michaud A, LeBlanc P, et al. Catabolic/anabolic balance and muscle wasting in patients with COPD. Chest. 2003;124(1):83-9.

Rahman I. Oxidative stress in pathogenesis of chronic obstructive pulmonary disease: cellular and molecular mechanisms. Cell Biochem Biophys. 2005;43(1):167-88.

Yang IA, Fong KM, Sim EH, Black PN, Lasserson TJ Inhaled corticosteroids for stable chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2007;CD002991.

Barberà JA, Peinado VI, Santos S. Pulmonary hypertension in chronic obstructive pulmonary disease. Eur Respir J. 2003;21(5):892-905.

Lam WK, So SY, Yu DY. Response to oral corticosteroids in chronic airflow obstruction. Br J Dis Chest. 1983;77(2):189 98.

Postma DS, Steenhuis EJ, van der Weele LT, Sluiter HJ. Severe chronic airflow obstruction: can corticosteroids slow down progression? Eur J Respir Dis. 1985;67(1):56-64.

Postma DS, Peters I, Steenhuis EJ, Sluiter HJ. Moderately severe chronic airflow obstruction. Can corticosteroids slow down obstruction? Eur Respir J. 1988;1(1):22-6.

Doherty DE, Tashkin DP, Kerwin E, Knorr BA, Shekar T, Banerjee S, et al. Effects of mometasone furoate/formoterol fumarate fixed-dose combination formulation on chronic obstructive pulmonary disease (COPD): results from a 52-week Phase III trial in subjects with moderate-to-very severe COPD. Int J Chron Obstruct Pulmon Dis. 2012;7:57-71.

Saha S, Siva R, Brightling CE, Pavord ID. COPD: an inhaled corticosteroid-resistant, oral corticosteroid-responsive condition. Eur Respir J. 2006;27(4):863-5.

Downloads

Published

2017-01-21

How to Cite

Kant, S., Ahmad, J., Siddiqui, M. J., Singh, A., Verma, A. K., & Bhatia, A. (2017). A comparative study to evaluate the role of inhaled steroid versus low-dose oral steroid in patients of chronic obstructive pulmonary disease. International Journal of Basic & Clinical Pharmacology, 4(2), 240–244. Retrieved from https://www.ijbcp.com/index.php/ijbcp/article/view/904

Issue

Section

Original Research Articles