Steroid Prednisone Effective Against Lung Disease Flare-Ups

(HealthDay News) – It’s not a cure—few steroids are—but prednisone, taken through an inhaler, can help ease the painful symptoms of chronic obstructive pulmonary disease (COPD).

This is not a small matter. More than 13 million Americans have COPD, which is the country's fifth leading cause of death, according to the U.S. government’s National Heart, Lung, and Blood Institute. Almost 118,000 people in the United States die each year from COPD, the lung association reports.

The most urgent of COPD’s symptoms is difficulty in breathing, and recent studies have found that those who need treatment in the emergency room should leave the hospital with a prescription for oral steroids along with antibiotics and an inhaler to help them breathe.

A Canadian study found that people who were given the oral steroid prednisone as part of their follow-up after being treated for a flare-up of chronic obstructive pulmonary disease (COPD) were less likely to have to go back to the hospital in a month than those who didn't take the drug.

"In Canada, only about 45 percent of patients were receiving prednisone after discharge from the emergency department," says the study's lead author, Dr. Shawn Aaron, associate professor of medicine at the University of Ottawa. "We wanted to see if [treatment] with prednisone… would improve the clinical outcome."

And it did, he says. Treating with prednisone "reduced relapses by 16 percent," according to Aaron, and also reduced shortness of breath and increased lung function.

COPD can actually be one of two diseases—chronic bronchitis or emphysema—or a combination of the two. The first symptoms of the disease are a mild shortness of breath and an occasional cough. As the disease progresses, sufferers develop a chronic cough, and it gets harder for them to breathe. Smoking is the biggest risk factor for getting COPD. The American Lung Association estimates that 80 percent to 90 percent of all cases involve smokers.

For this study, Aaron and his colleagues enrolled 147 people with COPD who were being discharged from an emergency room after suffering a flare-up of the disease. Half of the participants also were given 40 milligrams of prednisone for 10 days; the other half received a placebo.

Within a month, 43 percent of the placebo group had to visit the emergency department again. But, only 27 percent of the prednisone group had to go back to the hospital within a month.

"If you're sick with an exacerbation of COPD, you should be treated with antibiotics, bronchodilators and prednisone," concludes Aaron.

"This study shows they provide clinical benefits," adds Dr. Richard Irwin, who wrote an editorial in the New England Journal of Medicine when the study was published. "It's a small but statistically and clinically significant benefit." Irwin is chief of pulmonary, allergy and critical care medicine at the University of Massachusetts Memorial Medical Center.

Dr. Matthew Trunsky, a pulmonary medicine specialist in Troy, Mich., concurs. "Steroids are beneficial," Trunsky says. "Early use of steroids, within hours of the onset of symptoms, helps prevent exacerbations."

But, he cautions, "We need to keep an eye toward minimal doses because steroids have many side effects."

Side effects from short-term use of oral steroids are generally minimal. In this study, Aaron says, the most common side effects were insomnia, increased appetite and weight gain. He also notes that the use of steroids has been associated with an increased risk of osteoporosis.

On the Web

To learn more about chronic obstructive pulmonary disease, visit the U.S. government’s National Heart, Lung, and Blood Institute.

SOURCES: Shawn Aaron, M.D., Associate Professor of Medicine, University of Ottawa an Staff physician, Division of Respiratory Medicine, Ottawa Hospital, Canada; Matthew Trunsky, M.D., pulmonary medicine specialist, Troy and Royal Oak, Mich.; Richard Irwin, M.D., professor of medicine and chief of the Division of Pulmonary, Allergy and Critical Care Medicine, University of Massachusetts Medical School and University of Massachusetts Memorial Medical Center, Worcester, Mass.; June 26, 2003, New England Journal of Medicine
Publication date: February 12, 2007
Author: Serena Gordon, HealthDay Reporter
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