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Evidence summaries

Inhaled Steroids for Bronchiectasis

There is insufficient evidence on the effects of regular use of inhaled corticosteroids on lung function and symptoms in adults with stable state bronchiectasis. Level of evidence: "D"

A Cochrane review [Abstract] 1 included 6 adult studies (5 placebo controlled studies and 1 study with no treatment control group) with a total of 303 subjects with stable state bronchiectasis. There were no paediatric studies. All studies excluded patients with cystic fibrosis. In the short term group (inhaled corticosteroids [ICS] for less than 6 months duration), adults on huge doses of ICS (2 g per day of budesonide equivalent) had significantly improved FEV1 (MD 0.09, 95% CI 0.03 to 0.15; 3 studies, n=101), FVC (MD 0.09, 95% CI 0.02 to 0.16; 3 studies, n=101), Quality of life (QOL) score and sputum volume reduction (OR 7.69, 95% CI 1.92 to 30.70; 1 study, n=62) but no significant difference in peak flow, exacerbations, cough or wheeze, when compared to adults in the control arm (placebo or 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.

Comment: The quality of evidence is downgraded by study quality (unclear allocation concealment and lack of blinding), by inconsistency (heterogeneity in interventions and outcomes), and by imprecise results (limited study size for each comparison).

    References

    • Kapur N, Bell S, Kolbe J, Chang AB. Inhaled steroids for bronchiectasis. Cochrane Database Syst Rev 2009;(1):CD000996 [Review content assessed as up-to-date: 26 October 2010]. [PubMed].

Primary/Secondary Keywords