Corticosteroids chronic obstructive pulmonary disease

Johnson M (2004) Interactions between corticosteroids and beta2-agonists in asthma and chronic obstructive pulmonary disease. Proc Am Thorac Soc 1 200-6... 

The first commercially available DPI system appeared on the market in 1949, developed and marketed by Abbott under the name Aerohaler. Like all early pulmonary drug-delivery devices, it delivered small-molecule compoimds (bronchodilators or inhaled corticosteroids) to the airways (not necessarily the deep limg) for the treatment of asthma or chronic obstructive pulmonary disease. Table 6 lists some of the early DPI systems used for asthma and COPD the energy somces in these devices were mechanical and patient inspiration. 

Bourbeau J, Rouleau MY, Boucher S. Randomised controlled trial of inhaled corticosteroids in patients with chronic obstructive pulmonary disease. Thorax 1998 53 477-82. 

Burge S. Should inhaled corticosteroids be used in the long term treatment of chronic obstructive pulmonary disease . Drugs 2001 61(11) 1535-44. Review. 

Jarad NA, Wedzicha JA, Burge PS, Calverley PM. An observational study of inhaled corticosteroid withdrawal in stable chronic obstructive pulmonary disease. ISOLDE Study Group. Respir Med 1999 93(3) 161-6. 

Legionnaires disease is frequently characterized as an opportunistic disease, meaning that it most frequently attacks individuals who have an underlying illness or a weakened immune system. The most susceptible people include the aged, smokers, and immunosuppressed individuals. People with chronic obstructive pulmonary disease, organ transplant patients, and individuals on corticosteroid therapy are also at elevated risk. 

Carrascosa Porras M, Herreras Martinez R, Corral Mones J, Ares Ares M, Zabaleta Murguiondo M, Ruchel R. Fatal Aspergillus myocarditis following shortterm corticosteroid therapy for chronic obstructive pulmonary disease. Scand J Infect Dis 2002 34(3) 224-7. 

Blair GP, Light RW. Treatment of chronic obstructive pulmonary disease with corticosteroids. Comparison of daily vs alternate-day therapy. Chest 1984 86(4) 524-8. 

Bonay M, Bancal C, Crestani B. The risk/benefit of inhaled corticosteroids in chronic obstructive pulmonary disease. Expert Opin Drug Saf. 2005 4 251-271. 

Saprophytic colonization is found with increased incidence in patients with underlying pulmonary diseases, such as in advanced stages of chronic obstructive pulmonary disease, chronic asthma requiring administration of adrenal corticosteroids, primary ciliary dyskinesia syndrome and cystic fibrosis [4-7]. A.fumigatus is the predominant species cultured from the respiratory tract although other Aspergillus species may also be found occasionally. 

Chronic obstructive pulmonary disease is a respiratory condition characterized by irreversible airway obstruction caused by chronic bronchitis or emphysema. The major symptoms of COPD include chronic cough, increased sputum production, and dyspnea. The vast majority of patients with COPD are those who are current or former heavy smokers. Other risk factors for the development of COPD include occupational exposure (dusts, chemicals) and rare genetic disorders (a -antitrypsin deficiency). The medical management of COPD includes pharmacotherapy (bronchodilators, corticosteroids, and antibiotics) in combination with interventions to reduce risk factors for disease progression (e.g., smoking cessation). Some patients require long-term administration of supplemental oxygen. 

Callahan CM, Dittos RS, Katz BP. Oral corticosteroid therapy for patients with stable chronic obstructive pulmonary disease A meta-analysis. Ann Intern Med 1991 114 216-223. 

Davies L, Angus RM, Calverley PMA. Oral corticosteroids in patients admitted to hospital with exacerbations of chronic obstructive pulmonary disease A prospective, randomised, controlled trial. Lancet 1999 354 456-460. 

Jones A, Fay JK, Burr M, et al. Inhaled corticosteroid effects on bone metabolism in asthma and mild chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2002 1 CD003537. 

Singh S, Loke YK. Risk of pneumonia associated with long-term use of inhaled corticosteroids in chronic obstructive pulmonary disease a critical review and update. Curr Opin Pulm Med 2010 16(2) 118-22. 

Kim TW, Kim MN, Kwon JW, Kim KM, Kim SH, Kim W, Park HW, Chang YS, Cho SH, Min KU, Kim YY. Risk of hepatitis B virus reactivation in patients with asthma or chronic obstructive pulmonary disease treated with corticosteroids. Respir-ology 2010 15(7) 1092-7. 

Drummond MB, Dasenbrook EC, Pitz MW, Murphy DJ, Fan E. Inhaled corticosteroids in patients with stable chronic obstructive pulmonary disease a systematic review and meta-analysis. JAMA 2008 300(20) 2407-16. 

Singh S, Amin AV, Loke YK. Long-term use of inhaled corticosteroids and the risk of pneumonia in chronic obstructive pulmonary disease. Ann Intern Med 2009 169(3) 219-29. 

Budesonide is a glucocortical steroid for the treatment of asthma, chronic obstructive pulmonary disease (COPD) and noninfectious rhinitis, and for the treatment and prevention of nasal polyposis. If is also used for Crohn disease (CD). At the same time budesonide is contraindicated as a primary treatment of sfafus asthmaticus or ofher acufe episodes of asthma when intensive measures are required. Also, treatment with an inhaled corticosteroid and long-acting bronchodilator is recommended for severe/very severe COPD patients with repeated exacerbations. 

The adverse effect profile of both oral and inhaled corticosteroids (ICS) has been and continues to be studied extensively. Although ICS are among the most frequently used inhaled medications for asthma and chronic obstructive pulmonary disease (COPD), they are associated with several adverse effects, which were recently reviewed in three Cochrane meta-analyses. 

Yang lA, Qarke MS, Sim EH, Fong KM. Inhaled corticosteroids for stable chronic obstructive pulmonary disease. Cochrane Etatabase Syst Rev July 11,2012 7 CD002991. 

Persons aged 2 to 64 years who are at increased risk for pneumococcal disease or its complications if they become infected should be vaccinated. Persons at increased risk for severe disease include those with chronic illness such as chronic cardiovascular disease (e.g., congestive heart failure [CHF] or cardiomyopathies), chronic pulmonary disease (e.g., chronic obstructive pulmonary disease [COPD] or emphysema, and asthma that occurs with chronic bronchitis, emphysema, or long-term use of systemic corticosteroids), diabetes melli-tus, alcoholism, chronic liver disease (cirrhosis) (36-39), or cerebrospinal fluid leaks. 

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