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Inhaled steroids for bronchiectasis (Review)

Kapur, Nitin, Bell, Scott, Kolbe, John and Chang, Anne B. (2009). Inhaled steroids for bronchiectasis (Review)<br />. Cochrane Database of Systematic Reviews,2009(1 - Article No. CD000996).

Document type: Journal Article
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Title Inhaled steroids for bronchiectasis (Review)
Author Kapur, Nitin
Bell, Scott
Kolbe, John
Chang, Anne B.
Journal Name Cochrane Database of Systematic Reviews
Publication Date 2009
Volume Number 2009
Issue Number 1 - Article No. CD000996
ISSN 1464-780X   (check CDU catalogue  open catalogue search in new window)
Total Pages 25
Place of Publication United Kingdom
Publisher John Wiley & Sons Ltd.
HERDC Category C2 - Journal Article - Other contributions to refereed journal (internal)
Abstract Background
Bronchiectasis is increasingly recognized as a major cause of respiratory morbidity especially in developing countries and in some ethnic populations of affluent countries. It is characterized by irreversible dilatation of airways, generally associated with chronic bacterial infection. Medical management largely aims to reduce morbidity by controlling the symptoms and by preventing the progression of bronchiectasis.

Objectives

To evaluate the efficacy of inhaled corticosteroids (ICS) in children and adults with bronchiectasis (a) during stable bronchiectasis; and for reducing; (b) the severity and frequency of acute respiratory exacerbations and (c) long term pulmonary decline.

Search methods

The Cochrane Register of Controlled Trials (CENTRAL), the Cochrane Airways Group Specialized Register of trials, MEDLINE and EMBASE databases were searched by the Cochrane Airways Group. The latest searches were performed in October 2010.

Selection criteria

All randomised controlled trials comparing ICS with a placebo or no medication. Children and adults with clinical or radiographic evidence of bronchiectasis were included, but patients with cystic fibrosis (CF) were excluded.

Data collection and analysis

Results of searches were reviewed against pre-determined criteria for inclusion.

Main results

There were no paediatric studies. Six adult studies fulfilled the inclusion criteria. Of the 303 randomised, 278 subjects completed the trials. In the short term group (ICS for less then 6 months duration), adults on huge doses of ICS (2g per day of budesonide equivalent) had significantly improved forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), Quality of life (QOL) score and sputum volume but no significant difference in peak flow, exacerbations, cough or wheeze, when compared to adults in the control arm (no ICS). When only placebo-controlled studies were included, there were no significant difference between groups in all outcomes examined (spirometry, clinical outcomes of exacerbation or sputum volume etc). The single study on long term outcomes showed no significant effect of inhaled steroids in any of the outcomes.

Authors' conclusions

The present review indicates that there is insufficient evidence to recommend the routine use of inhaled steroids in adults with stable state bronchiectasis. While a therapeutic trial may be justified in adults with difficult to control symptoms and in certain subgroups, this has to be balanced with adverse events especially if high doses are used. No recommendation can be made for the use of ICS in adults during an acute exacerbation or in children (for any state) as there were no studies.
DOI http://dx.doi.org/10.1002/14651858.CD000996.pub2   (check subscription with CDU E-Gateway service for CDU Staff and Students  check subscription with CDU E-Gateway in new window)


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