P6. Corticosteroids

The effect of inhaled corticosteroids on the disease progression in COPD has been the subject of a series of controlled trials and systematic reviews and the effect remains unclear. A Cochrane systematic review found benefits of inhaled corticosteroids in reducing exacerbations and reducing decline in quality of life, but no consistent benefit on rate of decline in lung function or mortality (Yang 2012) [evidence level I]; see Section O3.2 Inhaled corticosteroids for details). While these data do not support the use of inhaled corticosteroids in all people with COPD, they are indicated for those with more severe disease (FEV₁ <50% predicted) and a history of frequent exacerbations.