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Meta-Analysis
. 2005 Feb 11:5:3.
doi: 10.1186/1471-2466-5-3.

Effects of inhaled corticosteroids on sputum cell counts in stable chronic obstructive pulmonary disease: a systematic review and a meta-analysis

Wen Qi Gan  1 , S F Paul Man, Don D Sin
Affiliations
Meta-Analysis

Effects of inhaled corticosteroids on sputum cell counts in stable chronic obstructive pulmonary disease: a systematic review and a meta-analysis

Wen Qi Gan et al. BMC Pulm Med. .

Abstract

Background: Whether inhaled corticosteroids suppress airway inflammation in chronic obstructive pulmonary disease (COPD) remains controversial. We sought to determine the effects of inhaled corticosteroids on sputum indices of inflammation in stable COPD.

Methods: We searched MEDLINE, EMBASE, CINAHL, and the Cochrane Databases for randomized, controlled clinical trials that used induced sputum to evaluate the effect of inhaled corticosteroids in stable COPD. For each chosen study, we calculated the mean differences in the concentrations of sputum cells before and after treatment in both intervention and control groups. These values were then converted into standardized mean differences to accommodate the differences in patient selection, clinical treatment, and biochemical procedures that were employed across original studies. If significant heterogeneity was present (p < 0.10), then a random effects model was used to pool the original data. In the absence of significant heterogeneity, a fixed effects model was used.

Results: We identified six original studies that met the inclusion criteria (N = 162 participants). In studies with higher cumulative dose (>or= 60 mg) or longer duration of therapy (>or= 6 weeks), inhaled corticosteroids were uniformly effective in reducing the total cell, neutrophil, and lymphocyte counts. In contrast, studies with lower cumulative dose (< 60 mg) or shorter duration of therapy (< 6 weeks) did not demonstrate a favorable effect of inhaled corticosteroids on these sputum indices.

Conclusions: Our study suggests that prolonged therapy with inhaled corticosteroids is effective in reducing airway inflammation in stable COPD.

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Figures

Figure 1
Figure 1
Study selection process
Figure 2
Figure 2
Effect of inhaled corticosteroids on total cell counts in the sputum of stable COPD patients
Figure 3
Figure 3
Effect of inhaled corticosteroids on neutrophils in the sputum of stable COPD patients
Figure 4
Figure 4
Effect of inhaled corticosteroids on lymphocytes in the sputum of stable COPD patients
Figure 5
Figure 5
Effect of inhaled corticosteroids on epithelial cells in the sputum of stable COPD patients
Figure 6
Figure 6
Effect of inhaled corticosteroids on eosinophils in the sputum of stable COPD patients
Figure 7
Figure 7
Effect of inhaled corticosteroids on macrophages in the sputum of stable COPD patients
Figure 8
Figure 8
Effect of inhaled corticosteroids on FEV11% predicted in stable COPD patients. Abbreviation: FEV1, forced expiratory volume in one second
See this image and copyright information in PMC

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