Role of corticosteroids in chronic obstructive pulmonary disease (COPD)

Chronic obstructive pulmonary disease (COPD) is mainly caused by smoking and presents with shortness of breath that is progressive and irreversible. In the third world use of biomass fuel has also been associated with COPD. It is a worldwide health problem and fourth most common cause of chronic disability and mortality even in developed countries. It is a complex disease in which both airway and lung parenchyma is involved. Inhaled corticosteroids (ICS) are widely used in clinical practice for the management of COPD however, their efficacy is still debated. They have shown beneficial effects on airway inflammation & infections and have also improved lung function and quality of life of COPD patients. There is epidemiological evidence that steroids might also protect against lung cancer in mild-moderate COPD but not so much in severe disease. This might be due to their effects on the process of epithelial mesenchymal transition (EMT), which is active in smokers and COPD. This opens up a new therapeutic area for the management/ treatment of lung cancer in COPD. In this chapter we have reviewed the current literature on role of ICS in COPD; especially focusing on the effects of ICS on airway inflammation, infections, remodeling changes including matrix changes and EMT. We also reviewed the literature on effects of ICS on lung cancer risk in COPD.