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Lapperre TS et al. – This randomized trial compared treatment with fluticasone for 6 months, fluticasone for 30 months, fluticasone and salmeterol for 30 months, or placebo in steroid–naive patients who had COPD, most of whom had airway hyperresponsiveness. Investigators found reduced inflammatory cells in sputum and bronchial biopsies and attenuated decrease in lung function during fluticasone treatment. Adding salmeterol did not further alter the decrease in lung function. Steroids not only reduce inflammation but can also slow decrease in lung function in some subphenotypes of steroid–naive patients with COPD.

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