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Objectives: To conduct a systematic review and meta-analysis regarding the efficacy and safety of inhaled corticosteroids for COPD exacerbationsin patients with lung disease (LD). Methods: A search of MEDLINE (1966-January 2003) for randomized, controlled trials of inhaled corticosteroids and controlled trials in COPD and a review of the medical literature were performed. Data were extracted using descriptive and quantitative methods. Publication bias was assessed using P<0.05. Results: Fifty-eight trials (19 randomized, 14 nonrandomized) evaluated inhaled corticosteroids for COPD exacerbations. Among the randomized controlled trials, 21 had a duration of ≤ or =6 months and four had a duration of 10 years or longer. The results were mixed with most findings favoring the inhaled agents compared to placebo. Most adverse events were mild but did result in treatment discontinuation. Most positive effects were associated with the shortest duration of intervention. The number needed to treat (NNT) to achieve a 50% reduction in mean annualized relapse rate with inhaled corticosteroids was 3.72 for patients with severe COPD and 2.71 for patients without COPD. In conclusion, patients with COPD are not adequately treated with inhaled corticosteroids. They may be more adequately treated with short term long term therapy. There may be a number of pharmacologic and nonpharmacologic factors associated with adverse effects that should be examined in future studies.Related Article: