So inhaled steroids slow the rate of decline of FEV1 in patients with COPD after all?

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Abstract
The medical community has made up its mind that, although inhaled corticosteroids reduce exacerbations in patients with chronic obstructive pulmonary disease (COPD),1 they do not affect disease progression.2 Despite measurement of forced expiratory volume in one second (FEV1) being widely available and a strong predictor of mortality,3 the emphasis has moved to softer outcome measures which do show changes with available treatments. Ten years ago many of us had different beliefs—several small studies using simple statistics suggested that the rate of decline in FEV1 could be reduced by about 20 ml a year by inhaled corticosteroids.4– 6 This led to several large studies, the primary outcome of which was decline in FEV1 and which were powered to detect a 20 ml/year difference between active and placebo treatments.7– 10 All failed to show significant differences in their primary outcome of FEV1 decline between various inhaled corticosteroids and placebo.

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