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To the Editor: The systematic review and meta-analysis by Dr Drummond and colleagues¹ drew on 11 randomized controlled trials involving inhaled corticosteroids of 6 months or longer duration in COPD to suggest that inhaled corticosteroid therapy was not associated with a survival benefit in these patients. However, a pooled analysis by Sin et al² drew on 6 of the 11 trials (references 10, 11, 14, 34, 36, and 37 in Drummond et al). It came to the conclusion that inhaled corticosteroids were associated with a 27% reduction in all-cause mortality in stable COPD, although none of the 6 studies (whose follow-up ranged from 9 to 42 months) were designed to evaluate mortality as an end point in either review.

The difference in conclusions could be because Drummond et al analyzed more trials (11 vs 6) or because the duration of follow-up was different (1 vs 2-3 years). We believe that . . . [Full Text of this Article]

James Wall, MRCP
jamewall@hotmail.com

Imran Aziz, FRCP
Department of Respiratory Medicine
Royal Albert Edward Hospital
Wigan, Lancashire, England

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