Jébrak G, Pichot-Vérité M H, Marceau A, Rullon I
Service de Pneumologie et de Réanimation respiratoire, Hôpital Beaujon, Clichy.
Presse Med. 2000 Sep 16;29(16):1479-87.
BASIS OF TREATMENT: Chronic obstructive pulmonary disease (COPD) is a common condition. Medical, and particularly drug, therapy still provides insufficiently effective relief. Corticosteroid treatment relies on the effect of these drugs on the underlying inflammatory mechanisms. Their efficacy has been demonstrated in asthma which exhibits certain features common with COPD.
Short-term corticosteroid regimens are generally well tolerated. Clinical data favor their use in certain cases of acute decompensation. Long-term systemic regimens are not warranted due to the risk of adverse effects and the difficulty in maintaining appropriate dosages. Inhaled corticosteroids are widely used although the efficacy remains controversial.
Clear evidence of efficacy from large controlled trials is still lacking. The difficulty encountered in obtaining such evidence is an indication of the minimal impact of such treatment and raises the question of its clinical pertinence. Patients exhibiting features similar to those observed in asthma (atopy, eosinophilia, improvement with bronchodilatation, non-smokers...) should be able to benefit from corticosteroids. For others a therapeutic test would be advisable to identify responders who could benefit from a preventive effect on the progression of COPD or associated asthma. A test lasting a few weeks at sufficient dosage is needed for subjective and objective (respiratory function tests) assessment. This costly therapy would not be warranted in non-responders, particularly in light of the expected secondary effects. Current evidence does not point to corticosteroid therapy as the much needed fully effective treatment for COPD.
治疗依据：慢性阻塞性肺疾病（COPD）是一种常见疾病。药物治疗，尤其是药物疗法，提供的缓解效果仍不够理想。皮质类固醇治疗依赖于这些药物对潜在炎症机制的作用。其疗效已在与COPD有某些共同特征的哮喘中得到证实。
短期皮质类固醇治疗方案一般耐受性良好。临床数据支持在某些急性失代偿病例中使用。由于存在不良反应风险以及维持适当剂量的困难，不建议长期采用全身治疗方案。吸入性皮质类固醇广泛使用，但其疗效仍存在争议。
大型对照试验仍缺乏明确的疗效证据。获取此类证据的困难表明这种治疗的影响极小，并引发了其临床相关性的问题。表现出与哮喘中观察到的特征相似（特应性、嗜酸性粒细胞增多、支气管扩张后改善、非吸烟者……）的患者应该能够从皮质类固醇中获益。对于其他患者，建议进行治疗试验以识别可能从对COPD进展或相关哮喘的预防作用中获益的反应者。需要进行为期数周的足够剂量试验，以进行主观和客观（呼吸功能测试）评估。对于无反应者，这种昂贵的治疗是不合理的，特别是考虑到预期的副作用。目前的证据并未表明皮质类固醇疗法是COPD急需的完全有效的治疗方法。
