What effect do inhaled steroids have on delaying the progression of COPD?

Abstract

The annual rate of decline in forced expiratory volume for 1 second (FEV1) has been researchers' gold standard as an objective measure for progression of chronic obstructive pulmonary disease (COPD). Inhaled corticosteroids (ICS) do not consistently have a statistically significant impact on FEV1 decline, and thus on the progression of COPD (strength of recommendation [SOR]: B, 2 conflicting meta-analyses and numerous conflicting randomized controlled trials). In those studies that did show improvements in FEV1 decline, the change does not appear to be clinically significant (7.7 to 9.0 mL/year). These findings do not take into account the potential impact of ICS on such patient oriented outcomes as exacerbation rates, quality of life, outpatient visits, hospitalization, and mortality.