Inhaled corticosteroids in COPD: risk and benefits

COPD is a progressive disease where airway inflammation plays an important part. Previously, there were large expectations that regular anti-inflammatory treatment with inhaled corticosteroids (ICS) might help stop disease progression. In 2007, the much-anticipated result from the Towards a Revolution in COPD Health study (TORCH) was published.1 The primary objective of TORCH was to see if the combination of the long-acting beta-agonist (LABA) and ICS would reduce mortality among patients with COPD. The study did not find a statistically significant survival benefit of the ICS/LABA treatment compared with placebo. However, somewhat unexpectedly, they found that pneumonia was more common in the treatment arms that had received ICS. In the group with ICS/LABA, 20% of the patients had at least one event of pneumonia compared with 12% in the placebo group. That ICS increases the risk of pneumonia in COPD has been confirmed in many subsequent randomised controlled trials (RCTs) and observational studies.2–4 In an observational study in this issue of the journal, Eklof and coworkers report that ICS treatment is associated with an increased risk of having a positive culture of Pseudomonas aeruginosa in patients with COPD.5 In the study, the authors have linked data from multiple national registers with microbiological data. The study included over 21 000 patients with COPD, of whom 763 (4%) had a …