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ESTEROIDES INHALADOS Y ENFERMEDAD PULMONAR OBSTRUCTIVA CRÓNICA

En pacientes con EPOC moderada que continúan fumando, el tratamiento a tres años con Budesonida se asocia con una ligera mejoría del FEV1 en los primeros 6 meses, que no se mantiene a largo plazo y que es mayor en los pacientes menos fumadores.

Pregunta:
En un paciente con EPOC, ¿es eficaz el tratamiento con esteroides inhalados para prevenir o enlentecer el deterioro funcional y mejorar el curso clínico?

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Best Evidence
(Issue 4,2001): steroid* or corticosteroid*/therapeutics. Documentos recuperados: 0

Cochrane
(Issue 4,2001):
  • #1 64 ((CHRONIC next OBSTRUCTIVE) and (AIRWAY next DISEASE*))
  • #2 1036 ((CHRONIC next OBSTRUCTIVE) and (PULMONARY next DISEASE*))
  • #3 81 ((CHRONIC next AIRFLOW) and LIMITATION)
  • #4 941 COPD
  • #5 6692 LUNG-DISEASES-OBSTRUCTIVE*:ME
  • #6 7265 ((((#1 or #2) or #3) or #4) or #5)
  • #7 4846 ASTHMA*:ME
  • #8 2524 (#6 not #7)
  • #9 1860 ADMINISTRATION-INHALATION*:ME
  • #10 11500 (((((STEROID* or CORTICOSTEROID*) or FLUTICASONE*) or BUDESONIDE*) or BECLOMETHASONE*) or TRIAMCINOLONE*)
  • 11 669 (#9 and #10)
  • #12 390 (INHAL* next (STEROID* or CORTICOSTEROID*))
  • #13 920 (#11 or #12)
  • #14 70 (#8 and #13)

Medline-Plus.Silver Platter/WinSPIRS
1/1990-9/2001:
  • #1 39923 explode "Lung-Diseases-Obstructive"/ all subheadings
  • #2 6805 (chronic obstructive pulmonary disease*) or copd or (chronic airflow limit*) or (obstructive airway* disease*)
  • #3 27039 explode "Asthma"/ all subheadings
  • #4 1774 (explode "Administration-inhalation"/all subheadings) and (steroid* or corticosteroid*)
  • #5 2317 inhal* near2 (steroid* or corticosteroid*)
  • #6 4078 fluticasone* or budesonide* or beclomethasone* or triamcinolone*
  • #7 3334072 human in tg
  • #8 1244792 (middle-age or adult) in age
  • #9 4297142 (spanish or english or french) in la
  • #10 105759 in-vitro in tg
  • #11 249261 (addresses or bibliography or biography or comment or congresses or dictionary or historical-article) in pt
  • #12 330035 (interview or lectures or legal-cases or letter or news or periodical-index or case-report) in pt
  • #13 15052 (#1 or #2) not #3
  • #14 5749 #4 or #5 or #6
  • #15 254 #13 and #14
  • #16 4694640 #7 or #8 or #9
  • #17 253 #15 and #16
  • #18 220 #17 not (#10 or #11 or #12)
  • #19 33823 (DOUBLE and BLIND*) in TI,AB
  • #20 40693 (DOUBLE and BLIND*) in mesh
  • #21 43994 PLACEBO* in TI,AB
  • #22 679 placebo in mesh
  • #23 63513 #19 or #20 or #21 or #22
  • #24 78 #18 and #23

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Documentos Preseleccionados  
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Health status deterioration in patients with chronic obstructive pulmonary disease. Spencer,-S; Calverley,-P-M; Sherwood-Burge,-P; Jones,-P-W. Am-J-Respir-Crit-Care-Med. 2001 Jan; 163(1): 122-8.

Effect of inhaled triamcinolone on the decline in pulmonary function in chronic obstructive pulmonary disease. N-Engl-J-Med. 2000 Dec 28; 343(26): 1902-9.

Randomised, double blind, placebo controlled study of fluticasone propionate in patients with moderate to severe chronic obstructive pulmonary disease: the ISOLDE trial. Burge,-P-S; Calverley,-P-M; Jones,-P-W; Spencer,-S; Anderson,-J-A; Maslen,-T-K . BMJ. 2000 May 13; 320(7245): 1297-303.

The effect of high-dose inhaled beclomethasone dipropionate in patients with stable COPD. Nishimura,-K; Koyama,-H; Ikeda,-A; Tsukino,-M; Hajiro,-T; Mishima,-M; Izumi,-T .Chest. 1999 Jan; 115(1): 31-7.

Long term effects of inhaled corticosteroids in chronic obstructive pulmonary disease: a meta-analysis. Van-Grunsven,-P-M; van-Schayck,-C-P; Derenne,-J-P; Kerstjens,-H-A; Renkema,-T-E; Postma,-D-S; Similowski,-T; Akkermans,-R-P; Pasker-de-Jong,-P-C; Dekhuijzen,-P-N; van-Herwaarden,-C-L; van-Weel,-C. Thorax. 1999 Jan; 54(1): 7-14.

Long-term effect of inhaled budesonide in mild and moderate chronic obstructive pulmonary disease: a randomised controlled trial. Vestbo,-J; Sorensen,-T; Lange,-P; Brix,-A; Torre,-P; Viskum,-K . Lancet. 1999 May 29; 353(9167): 1819-23.

Long-term treatment with inhaled budesonide in persons with mild chronic obstructive pulmonary disease who continue smoking. European Respiratory Society Study on Chronic Obstructive Pulmonary Disease. Pauwels,-R-A; Lofdahl,-C-G; Laitinen,-L-A; Schouten,-J-P; Postma,-D-S; Pride,-N-B; Ohlsson,-S-V. N-Engl-J-Med. 1999 Jun 24; 340(25): 1948-53.

Multicentre randomised placebo-controlled trial of inhaled fluticasone propionate in patients with chronic obstructive pulmonary disease. International COPD Study Group. Paggiaro,-P-L; Dahle,-R; Bakran,-I; Frith,-L; Hollingworth,-K; Efthimiou,-J. Lancet. 1998 Mar 14; 351(9105): 773-80.

Randomised controlled trial of inhaled corticosteroids in patients with chronic obstructive pulmonary disease. Bourbeau,-J; Rouleau,-M-Y; Boucher,-S. Thorax. 1998 Jun; 53(6): 477-82.

Inhaled budesonide therapy for patients with stable COPD. Weiner,-P; Weiner,-M; Azgad,-Y; Zamir,-D. Chest. 1995 Dec; 108(6): 1568-71.
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Artículo Seleccionado  
Long-term treatment with inhaled budesonide in persons with mild chronic obstructive pulmonary disease who continue smoking. European Respiratory Society Study on Chronic Obstructive Pulmonary Disease. Pauwels,-R-A; Lofdahl,-C-G; Laitinen,-L-A; Schouten,-J-P; Postma,-D-S; Pride,-N-B; Ohlsson,-S-V. N-Engl-J-Med. 1999 Jun 24; 340(25): 1948-53.
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Razones para la selección del artículo: Ensayo clínico terapéutico, gran número de pacientes, tratamiento a largo plazo (3 años), desenlaces funcionales y eventos y efectos adversos bien planteados.

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Mejor idea de la década. Diario Médico
Grupo de Medicina Basada en la Evidencia. Servicio de Neumología. Hospital Universitario 12 de Octubre
Grupo de Medicina Basada en la Evidencia
Hospital Universitario 12 de Octubre

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Última modificación: 01/04/2014