British Lung Foundation
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Efficacy and safety of inhaler steroids in COPD patients

Once again, I've been rummaging around on the internet looking for more information and found this from the National Institutes of Health:

ncbi.nlm.nih.gov/pmc/articl...

"...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 In a previous meta-analysis [unpublished data] of randomized placebo controlled trials investigating potential effects of β2-agonists on COPD patients’ outcome, we also reached to similar findings for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..."

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As a newly diagnosed COPDer I'm very interested to read this. I am only mild at the moment, (although I am struggling at moment due to a head cold) and my GP has not prescribed any steroids as yet. I'm intending to up my exercise levels in the new year,. Although it sounds as if a steroid inhaler should be part of a rescue pack? I don't have a rescue pack yet and I'm not sure what an exacerbation is but I guess I will know when it hits..so will nite about the other anti inflammatory drug for future ref. Thankyou for posting.

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Annbeth,

I tried to pick out and post the 'kernel' of what the article is all about; I just took myself off Symbicort, an inhaler that contains a corticosteroid and switched to another type, Stiolto which has none. I was on Symbicort for over 5 years with no improvement and the only change was that my skin was thinning and was more easily damaged and bruised. I stopped about 45 days ago and all that has cleared up.

I hope one of the lessons you learn from being in this group is to do your own research from reliable sources (beware, there's plenty of garbage on the net) and speak with your doctor about your finds, mebbe even taking a print out so he/she can read for themselves.

There don't seem to be any fast and ready answers to this disease, except for a couple that're universally agreed upon and those are exercise and diet.

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Thanks dmactds, immvery wary of a lot of so called research that is out in the public domain..usually using heathy people or are not statistically significant. But you have given me another thing to be aware of, my skin is already quite thin and I bruise easily so I must be aware of this for the future ..whatever that brings..thanks

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Have you found that your breathing is better with the Stiolto inhaler?

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No..., I can't say for certain that my breathing is a lot better with Stiolto, but then no medicine I've taken since my renal lung failure 5 plus years ago HAS changed anything; I mean, I'm certainly not breathing in a field of butterflies and flowers like the ads suggest and not even like I was before all this happened.

What HAS changed is that now my skin is not as thin and doesn't tear as easily and the easily bruised events have lessened and generally I simply feel better without all that steroid mess sloshing around in me.

The main thing that's made a difference with me is not allowing myself to get hooked into thinking I can't make it without an oxygen tank; I do without nearly constantly now, though I still have plenty of the canisters around. I finally figured out fairly early on that wearing one of those strapped over my shoulder wore me out about the same as if I didn't have one at all.

The worst time for me is like right now, first thing in the morning, when my body is trying to get used to being upright again for the day.

It's nearly 5 am and I'll be shuffling next door in a few minutes to put my worse off, 82 year old neighbor's paper on the porch where she can snag it with her "pick up" stick. Then after shuffling back home, I'll fix a bit of breakfast and probably take a small nap; after which, everything is just ducky, rosy for the most part.

This has been a long answer to your short, concise question but it's meant to convey my general 'spriteliness' of living and well being...; that is, as 'spritely' as one can be at seventy-five.

Shalom

Duncan

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Thanks for your very comprehensive reply Duncan - it has really helped me because I have had a lot of questions about medications/inhalers etc since becoming ill and given 3 courses of ABs then 3 courses of steroids since mid October (hospitalised for 3 days mid November). Just finished last course of steroids & today have been doing lung clearance for 3 hours (saw a very fine thread of blood for first time today). I believe its bronchitis (acute/chronic?) but no-one has specifically diagnosed it; even the hospital - they did tell me it was due to inflammation, as opposed to infection, but that was all. They sent me home with steroids and change of inhaler. As soon as steroids finished I became very ill again. Have asked for, and been referred to lung consultant, but goodness knows how long that will take. I feel as if I have been left to my own devices, and when things get bad I'm given another course of steroids to keep me quiet for a while! Hence am trying to narrow down what exactly is happening to me. Phew! That was quite long-winded, while saying not much at all !! Anyway, thanks again. To know others' symptoms and how they are coping really helps.

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This may be true for 'pure' copd but many of us have overlapping conditions. Prior to diagnosis of copd (age 55), I had asthma throughout my adult life, which as time went on, needed to be treated with inhaled steroids. Flare-ups never responded to theophylline. I was treated with a range of medications but the only thing which helped was symbicort, though presumably a different inhaled steroid might also have helped.

Many of us with copd have historically had asthma - they often go together but are not the same condition and it is not always easy to distinguish them. As my consultant has said many times in multi-disciplinary training sessions Ive been at as a patient rep, if you have both you have double the problems. Where asthma is also present, inhaled steroids are often essential, despite the obvious risks.

Everything stated about exercise is of course correct. I do loads and I wish that was enough to manage my copd.

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I send these little blurbs along for information purposes only...., NOT as any kind of gospel. Some of it may be pertinent and some of it may not apply...,

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It's important we see these bits of research, didn't mean to suggest otherwise. Important too to get members' impressions and reactions.

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Thanks for posting this. I’ve been on qvar and nasacort for a long time. They are both steroids. I was given nasacort for a polyp in my nose. I tried cutting down on them both but developed a cough that wouldnt go away. I was told by my asthma nurse to go back on it. My skin is so thin that my arms look as if I’ve been beaten all the time. I also find everything a hazard for my skin. I’ve had a pushchair pierce my leg and had to go to hospital to have it stitched. My Sons dog was pleased to see me and ripped my arm. That was seri stripped. On my last holiday I managed to rip my arm quite badly and that cost 325 euros. It was steri stripped but should have been stitched. I now have a nasty scar. Luckily the insurance payed out. I’ve had many other things too that a normal skin would hardly even mark. My arms are covered in scars. I’ve got mild asthma and I find the steroids keep it under control. When I first took inhaled steroids I was assured that it got contained in the lungs and you wouldn’t have any side effects. Had I known I may have been a bit more cautious about it. I will certainly look into this more closely. Thank you once again for the information.

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According to Stiolto's packaging info and background I found online, it has pretty much the same as Simbicort but without steroids, if that's of any help...., but I suppose your docs really think you NEED the steroids, eh?

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I dont understand your reply, Duncan, though I know nothing about Stiolto.

Symbicort is a combination a steroid (Budesonide) and a long acting bronchodilator (formoterol, itself a risk for pneumonia, I've read).

So in saying Stiolto is the same as Symbicort but without the steroids, are you saying that Stiolto is basically a bronchodilator? Which is equivalent to just one of the Symbicort components. Bit like saying bacon and eggs is the same as bacon, but without the eggs ;)

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Just googled Stiolto - two main ingredients are Olodaterol, a LABA as is the Formoterol in Symbicort, AND tiotropium which is an anti-cholinergic medication, totally different to steroids. The Stiolto blurb may sound similar to Symbicort as functionally all the copd meds are supposed to relax the airways and make it easier to breathe. But tiotropium is a totally different class of drug to Budesonide.

There is now the new(ish) "triple therapy" which is inhalers that contain a steroid, a LABA (long acting bronchodilator), and a LAMA (long-acting muscarinic medication). I would love to try this but every time Ive tried spiriva, tiotropium, seebri etc - all anti-muscarinic meds, Ive found them to dry me out to such an extent that my mouth and throat sticks to itself and I can't even speak :( My consultant wants to try the new triple thingy and I will give it a go as he says there are different versions which don't all have the same side effects.

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Well done/said..., back to bed.

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Best place to be on such a grey wet day. zzzzz zzzzz zzzzz :)

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I might not live longer because of inhaled steroids but certainly the quality of my life however short absolutely depends on them - I cannot catch my breathe in the morning until I have my inhalers so research like this scares me - it might be cost efficient but I'd rather breath - and yes my skin is thin but a price I am prepared to pay. Thank you for the info. xx

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Interesting article, makes you start to wonder what is the best treatment for COPD apart from treating the symptoms of a flare up, especially as most drugs used on a long term basis have some kind of side effects. Plus there is the option of cheaper alternatives that may work just as well freeing up vital funds to help other NHS patients with treatment.Of course there is the problem of difficulties in changing long term drugs that a persons body is used too, I am sure there would be some effects on patients bodies like minor withdrawel symptoms maybe. I personally don't like change of things that seem to work for me, as it often results in health upsets. So we shall see what the outcome is from this research.

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You're paying the fiddler..., so dance to your own music.

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