COPD is a progressive disease where airway inflammation plays an important part. Previously, there were large expectations that regular anti-inflammatory treatment with inhaled corticosteroids (ICS) might help stop disease progression. In 2007, the much-anticipated result from the Towards a Revolution in COPD Health study (TORCH) was published.1 The primary objective of TORCH was to see if the combination of the long-acting beta-agonist (LABA) and ICS would reduce mortality among patients with COPD. The study did not find a statistically significant survival benefit of the ICS/LABA treatment compared with placebo. However, somewhat unexpectedly, they found that pneumonia was more common in the treatment arms that had received ICS. In the group with ICS/LABA, 20% of the patients had at least one event of pneumonia compared with 12% in the placebo group. That ICS increases the risk of pneumonia in COPD has been confirmed in many subsequent randomised controlled trials (RCTs) and observational studies.2–4 In an observational study in this issue of the journal, Eklöf and coworkers report that ICS treatment is associated with an increased risk of having a positive culture of Pseudomonas aeruginosa in patients with COPD.5 In the study, the authors have linked data from multiple national registers with microbiological data. The study included over 21 000 patients with COPD, of whom 763 (4%) had a …

中文翻译：

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慢性阻塞性肺病患者吸入皮质类固醇：风险和益处

COPD是一种进行性疾病，其中气道炎症起着重要作用。此前，人们普遍期望吸入性皮质类固醇 (ICS) 进行常规抗炎治疗可能有助于阻止疾病进展。2007 年，备受期待的 COPD 健康革命研究 (TORCH) 结果发表。 1 COPD患者的死亡率。与安慰剂相比，该研究未发现 ICS/LABA 治疗具有统计学意义的生存益处。然而，有点出乎意料的是，他们发现肺炎在接受 ICS 的治疗组中更为常见。在 ICS/LABA 组中，20% 的患者至少发生过一次肺炎事件，而安慰剂组为 12%。ICS 会增加 COPD 肺炎的风险，这已在随后的许多随机对照试验 (RCT) 和观察性研究中得到证实。2-4 在本期杂志的一项观察性研究中，Eklöf 及其同事报告说，ICS 治疗与COPD 患者铜绿假单胞菌培养阳性的风险增加。5 在这项研究中，作者将来自多个国家登记处的数据与微生物学数据联系起来。该研究包括超过 21 000 名 COPD 患者，其中 763 名（4%）患有…… Eklöf 和同事报告说，ICS 治疗与 COPD 患者铜绿假单胞菌培养阳性的风险增加有关。5 在这项研究中，作者将来自多个国家登记处的数据与微生物学数据联系起来。该研究包括超过 21 000 名 COPD 患者，其中 763 名（4%）患有…… Eklöf 和同事报告说，ICS 治疗与 COPD 患者铜绿假单胞菌培养阳性的风险增加有关。5 在这项研究中，作者将来自多个国家登记处的数据与微生物学数据联系起来。该研究包括超过 21 000 名 COPD 患者，其中 763 名（4%）患有……