Asthma and chronic obstructive pulmonary disease (COPD) are characterized by airflow limitation. Because asthma and COPD have different pathogenesis and therapeutic response, treatment guidelines differ for the two conditions. Current treatment guidelines for asthma suggest that daily long-term control medications are necessary to prevent exacerbations and chronic symptoms. Inhaled corticosteroids (ICSs) are preferred because of their ability to control the underlying inflammatory processes. Current treatment guidelines for COPD are not as clear, in part because only smoking cessation is reliably shown to slow the rate of decline in lung function. Some medications, however, can reduce or alleviate symptoms, increase exercise capacity, reduce the number and severity of exacerbations, and improve health status. Although the Food and Drug Administration has not approved ICSs as a monotherapy for the treatment of COPD, they are believed to improve some clinical outcomes. The purpose of this review is to help policy makers and clinicians make informed choices about the use of ICSs in the treatment of asthma and COPD.

Contents

• Introduction
  • A. Overview
  • B. Scope and key questions
• Methods
  • A. Literature search
  • B. Study selection
  • C. Data abstraction
  • D. Quality assessment
• Results
  • Key Question 1 For outpatients with asthma or COPD, do inhaled corticosteroids differ in effectiveness?
  • Key Question 2 For outpatients with asthma or COPD, do inhaled corticosteroids differ in safety or adverse events?
  • Key Question 3 Are there subgroups of patients based on demographics (age, racial groups, sex), other medications (drug-drug interactions), comorbidities (drug-disease interactions), or pregnancy for which one inhaled corticosteroid is more effective or associated with fewer adverse events?
• Summary
• Addendum: Are there device- or dosing-specific differences in inhaled corticosteroid products that lead to differences in adherence, persistence, effectiveness, tolerability, or patient preferences for treatment?
  • Introduction
  • Study Selection
  • Results
  • Conclusions
• References
• Appendixes
  • Appendix A: Search Strategy
  • Appendix B. Quality assessment methods for drug class reviews for the Drug Effectiveness Review Project
  • Appendix C: Characteristics of Excluded Studies
  • Appendix D: Placebo-controlled Trials of Inhaled Corticosteroids (not included)
  • Appendix E: Abstract-only Studies (not included)
  • Appendix F: Acknowledgements
• Evidence Tables

Oregon Evidence-based Practice Center, Oregon Health & Science University, Mark Helfand, MD, MPH, Director

Suggested citation:

Hansen RA, Gartlehner G, Lohr KN, Carson S, Carey T. Drug Class Review on Inhaled Corticosteroids. 2006. http://www.ohsu.edu/drugeffectiveness/reports/final.cfm

The purpose of this report is to make available information regarding the comparative effectiveness and safety profiles of different drugs within pharmaceutical classes. Reports are not usage guidelines, nor should they be read as an endorsement of, or recommendation for, any particular drug, use or approach. Oregon Health & Science University does not recommend or endorse any guideline or recommendation developed by users of these reports.