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Heavy smokers with chronic obstructive pulmonary disease (COPD) seem to respond less well to inhaled corticosteroids (ICS) than never, light or exsmokers, researchers told the recent Royal Pharmaceutical Society conference.

The authors reviewed three studies that involved 1,281 people. COPD severity ranged from mild to very severe. The dose and frequency of ICS used were similar in all three studies.

After using ICS for six months, never-smokers, ex-smokers and light smokers showed improvements in forced expiratory volume in 1 second (FEV1) ranging from 120-300ml. In people who smoked heavily, changes in FEV1 ranged from a worsening of €“300ml to a 197ml improvement.

Several factors could contribute to the impaired responsiveness including steroid resistance and differences between the groups in: COPD severity; bronchodilators and other concomitant medications; and study methodology. Further studies are needed to ascertain the causes of reduced ICS responsiveness in heavy smokers, say the authors.