Once again, I've been rummaging around on the internet looking for more information and found this from the National Institutes of Health:
"...The finding of this study that inhaled steroids have no significant survival effect in COPD patients is consistent with some previous meta-analyses (23-25). The current systematic review and meta-analysis using updated data including more recent data from the literature corroborated the findings from the previous meta-analyses. In a previous meta-analysis [unpublished data] of randomized placebo controlled trials investigating potential effects of β2-agonists on COPD patients’ outcome, we also reached to similar findings for this agent groups, with no survival effect on them.
Putting together, since traditional treatment protocols for COPD include inhaler beta agonists and steroids, we believe that these data suggest that the therapeutic strategies employed to manage COPD do not promise outcome advantages and new approaches are needed to control the disease in this patient population.
As mentioned before, this meta-analysis, however, showed some beneficial effect for inhaled steroids in reducing the rate of exacerbation episodes in COPD patients.
This finding is of high importance, because we know that exacerbations do not only affect quality of life of COPD patients, but also can increase mortality (26, 27).
Nevertheless, some recent studies have proposed similar effects for exercising and pulmonary rehabilitation in COPD patients. Seymour et al. (28) in their trial of 3 months found that exercise can reduce execrbation rates in COPD patients.
Similar favorable effects have also been detected on the quality of life of COPD patients undergoing pulmonary relhabilitation (29).
There is even suggestive line of evidence of survival benefits of rehabilitation for COPD patients (30). So, the authors of the current article believe that inhaled steroids due to non-significant survival effects as well as the significant rate of side effects are not suitable choices for COPD management, and can be safely substituted by less costly and safer therapeutic strategies like exercise.
Moreover, this study showed a better tolerance to inhaled steroids representing lower withdrawal rate than placebo. This observation is also suggestive of some relieving effect for this drug on COPD disease burden, and may be suggestive of some quality of life advantage.
However, as mentioned before, this range of advantages would not cover the disadvantages of the drug’s side effects, and when we could use rehabilitation therapy with comparable benefits and fewer deleterious effects; there would not be any indication for administration of them.
Moreover, there is increasing evidence for the beneficial effects of anti-inflammatory drugs like theophylline in COPD patients which may be able to promise better outcome with fewer side effects than inhaled steroids..."