Inhaled corticosteroids for cystic fibrosis

NICE Quality and Productivity Case Studies
Queen's University Belfast
Publication date:
20 January 2017


NICE summary of Cochrane review conclusions

Evidence does not support the routine use of inhaled corticosteroids (ICS) as anti-inflammatory agents in children and adults with cystic fibrosis (CF). There is no evidence of objective improvements in lung function or subjective improvements in exercise tolerance or quality of life. ICS should only be used for the symptomatic relief of recurrent wheezing that is not responsive to bronchodilators alone. Outside of this indication they are likely to result in more harm than benefits.

The ‘Implications for practice’ section of the Cochrane review stated:

‘This review has found little evidence from existing trials to support the practice of routinely prescribing inhaled steroids in CF. Specifically, we cannot conclude that inhaled steroids are beneficial but there is some evidence that at a high dose, they adversely effect growth. There is also some evidence that withdrawal of ICS in the majority of those already being treated with them is safe. We recommend that the use of ICS should be restricted to those with symptomatic wheezing and in whom benefit has been proven. Individuals should be regularly reassessed to see whether ICS are having an effect and consideration should always be given to reducing the dose or stopping the drugs altogether.’