Comes. duration of viagra effects Search strategy:  a pre-defined search strategy was used to search the cochrane airways group specialised register for relevant literature. Searches are current as of july 2011. viagra for sale Selection criteria:  we included randomised trials comparing any dose of any type of inhaled steroid with a placebo control in patients with copd. Acute bronchodilator reversibility to short-term beta2-agonists and bronchial hyper-responsiveness were not exclusion criteria. cheap viagra online The a priori primary outcome was change in lung function. We also analysed data on mortality, exacerbations, quality of life and symptoms, rescue bronchodilator use, exercise capacity, biomarkers and safety. Data collection and analysis:  two review authors independently assessed trial quality and extracted data. buy generic viagra We contacted study authors for additional information. We collected adverse effects information from the trials. Main results:  fifty-five primary studies with 16,154 participants met the inclusion criteria. Long-term use of ics (more than six months) did not consistently reduce the rate of decline in forced expiratory volume in one second (fev1) in copd patients (generic inverse variance analysis: mean difference (md) 5. 80 ml/year with ics over placebo, 95% confidence interval (ci) -0. 28 to 11. 88, 2333 participants; pooled means analysis: 6. 88 ml/year, 95% ci 1. viagra india online pharmacy 80 to 11. 96, 4823 participants), although one major trial demonstrated a statistically significant difference. There was no statistically significant effect on mortality in copd patients (odds ratio (or) 0. can buy viagra over counter uk 98, 95% ci 0. 83 to 1. 16, 8390 participants). Long-term use of ics reduced the mean rate of exacerbations in those studies where pooling of data was possible (generic inverse variance analysis: md -0. 26 exacerbations per patient per year, 95% ci -0. buy generic viagra online 37 to -0. order viagra online 14, 2586 participants; pooled means analysis: md -0. 19 exacerbations per patient per year, 95% ci -0. 30 to -0. 08, 2253 participants). viagra how long to kick in Ics slowed the rate of decline in quality of life, as measured by the st george's respiratory questionnaire (md -1. viagra india online pharmacy 22 units/year, 95% ci -1. 83 to -0. 60, 2507 participants). Response to ics was not predicted by oral steroid response, bronchodilator reversibility or bronchial hyper-responsiveness in copd patients. generic viagra canada There was an increased risk of orop.