Clinical Review Recent advances

Respiratory medicine

BMJ 2001; 323 doi: (Published 08 December 2001) Cite this as: BMJ 2001;323:1349
  1. Huib A M Kerstjens, respiratory physician (,
  2. Harry J Groen, respiratory physician,
  3. Wim van der Bij, physician in internal medicine
  1. Department of Pulmonary Medicine, University Hospital Groningen, NL-9700 RB Groningen, Netherlands
  1. Correspondence to: H A M Kerstjens

    Caring for patients with chronic obstructive pulmonary disease (COPD) will present a major challenge over the next decade. Due to a combination of factors including past and present smoking habits and an ageing population it is the only major chronic disease that is still associated with rising mortality. Rising rates of smoking in developing countries and the impact of women “catching up” with men's smoking habits will further affect the development of COPD, as well as lung cancer. This review focuses primarily on COPD, asthma, oncology, and lung transplantation, where in each case recent evidence has been, or is likely to be, associated with advances in clinical management.


    After discussion within our large group of pulmonary physicians we selected topics under four broad headings. Three of these—COPD, asthma, and lung cancer—were chosen because of the prevalence of the disease. We added a fourth, lung transplantation, because it is the treatment of last resort for several pulmonary diseases. Articles from 1999 onwards were considered.

    Chronic obstructive pulmonary disease

    Inhaled corticosteroids

    Many patients with COPD are still treated with inhaled corticosteroids despite the lack of evidence on their value. Four recent large scale multicentre trials have now established that inhaled corticosteroids have no effect on the rate of progressive decline of lung function in patients with COPD.1-4 This was the primary outcome in all four studies, and although two found that corticosteroid treatment had a favourable effect on secondary outcomes (the frequency of exacerbations and the use of health care services), these findings need to be confirmed in trials specifically designed to address these questions. Until then, most patients with COPD should not be treated with inhaled corticosteroids because of the significant risk of adverse effects including skin bruising2 and osteoporosis.4

    Recent advances

    Recent trials have shown that inhaled corticosteroids do not prevent progressive decline in lung …

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