The benefits of inhaled corticosteroids (ICS) in preventing COPD exacerbations seem to be overstated, according to the findings of a systematic review and meta-analysis.

Researchers searched the published literature (1988-2008) for RCTs that evaluated the efficacy of ICS vs placebo in preventing COPD exacerbations, and carried out a systematic review and meta-analysis. They also performed a meta-regression of trials to evaluate the risk reduction with every percentage decline in baseline values of FEV1 across studies. They identified 11 studies (8164 patients) and reported the following findings:

• The use of ICS was associated with reduction in the occurrence of exacerbations (relative risk, 0.82; 95% CI, 0.73 to 0.92).

• There was the presence of significant statistical heterogeneity but no evidence of publication bias.

• Sensitivity analysis revealed benefit of ICS only in patients with FEV1 < 50% (0.79; 0.69 to 0.89).

• A meta-regression analysis failed to demonstrate a linear relationship between FEV1 values and decline in COPD exacerbations with the use of ICS.

The researchers concluded that there is only a modest benefit of ICS in preventing COPD exacerbations, which is not related to the level of baseline lung function. They call for a reappraisal of the role of ICS in the prevention of COPD exacerbations.