Chronic inflammatory diseases of the airway, such as asthma and chronic obstructive pulmonary disease (COPD), are common and represent a substantial amount of the workload of most respiratory physicians. While medications for asthma provide good control of the disease in the majority of cases 1, pharmacotherapy for COPD is less satisfactory since none of the existing drugs has been shown to have a significant effect on the long-term decline in lung function that is the hallmark of this disease 2. It is, however, underlined in the international guidelines that COPD is a treatable disease 2. Current strategy in managing stable COPD includes several individualised interventions directed at different aspects of the disease. Most of these interventions are nonpharmacological, such as smoking cessation to prevent the accelerated loss of lung function, influenza and pneumococcal vaccines to prevent respiratory infections, exercise training to improve exercise tolerance and dyspnoea, nutritional support to avoid weight loss, and long-term administration of oxygen to increase survival in patients with chronic respiratory failure. Pharmacotherapy with long-acting bronchodilators is used to reduce symptoms and exacerbations. The addition of inhaled corticosteroids further reduces the frequency of exacerbations in patients with severe COPD 3, 4.
This issue of the European Respiratory Journal features a study by Siva et al. 5, who focused their intervention on an aspect of COPD that has never been considered before. These investigators tested the hypothesis that treatment with corticosteroids aimed at maintaining sputum eosinophils at <3% in COPD patients is associated with a reduction in exacerbations of COPD. A total of 82 patients with moderate-to-very severe COPD were randomised into two groups and the follow-up was extended for 12 months. One group was treated according to conventional British Thoracic Society (BTS) guidelines …
