The study included 1,007 COPD patients aged 35 to 64 and 4,022 over-65s who were assessed 90 to 365 days after being discharged from hospital.  

In the over-65s, a mortality rate of 11.7 per cent was noted in those taking inhaled corticosteroids, compared with 13.1 per cent in those not taking inhaled corticosteroids.  

The effect was even stronger in the younger group, with a mortality rate of 3.3 per cent in those given inhaled corticosteroids and 6 per cent in those who were not.  

In all cases, the most significant benefit, reducing both cardiovascular and COPD mortality rates, was seen when inhaled corticosteroids were given within 30 days of hospital discharge.  

Compared with patients treated with bronchodilators alone, those given just inhaled steroids had a 23 per cent reduced risk of mortality.  

Previous studies have suggested that bronchodilators may increase the risk of cardiovascular events, potentially explaining the increased mortality risk among those taking the medication. Inhaled corticosteroids may negate or reduce this effect.  

Findings from the Towards a Revolution in COPD Health (TORCH) study presented last month at the European Respiratory Society annual meeting in Munich, Germany showed that a combined long-acting beta-agonist and corticosteroid inhaler improved lung function and reduced rate of exacerbations in COPD compared with placebo.  

David Price, professor of respiratory medicine at Aberdeen University, who is involved with the research, said: ‘The main reason to treat COPD is to make the patient feel better and reduce exacerbations.’  

Dr Steve Holmes, a GP in Somerset and chairman of the General Practice Airways Group, said that increased risk of mortality with bronchodilators has been shown before but that ‘the majority of research supports NICE guidance’.  

The clinical guideline on COPD published in 2004 recommends that patients with moderate to severe COPD should be treated with one or more bronchodilators initially. If symptoms persist, GPs can consider adding an inhaled corticosteroid and, after that, a theopylline.  

Professor Martyn Partridge, a member of the British Thoracic Society executive committee, said the latest study added to a growing evidence base that supports NICE guidance.  

‘What they all tell us is that COPD is a multi-system disease with lots of comorbidity and we see in this study and the TORCH study evidence that we can improve survival in COPD with inhaled medication,’ he said.