Corticosteroid therapy and chronic obstructive pulmonary disease.

Chronic obstructive pulmonary disease is characterized in part by a chronic inflammatory state in the airways (largely from chronic noxious stimuli such as tobacco smoke), punctuated with acute inflammatory exacerbations, which are often infectious. Although pathologically and biochemically different from the inflammation of asthma, the chronic inflammation of chronic obstructive pulmonary disease, especially in subgroups with asthma-like features and especially during exacerbations, might be expected to respond to corticosteroid therapy, as does asthma. Complications from long-term corticosteroid use are important, but they appear less when the corticosteroid is given via the inhaled route. Clinical evidence is particularly strong supporting the use of inhaled corticosteroids to prevent exacerbations and oral corticosteroids to reduce the duration and impact of exacerbations.