The efficacy of inhaled corticosteroids in the management of non asthmatic chronic airflow obstruction
Boothman-Burrell, D.; Delany, S.G.; Flannery, E.M.; Hancox, R.J.; Taylor, D.R.
New Zealand Medical Journal 110(1053): 370-373
1997
ISSN/ISBN: 0028-8446 PMID: 9364183 Document Number: 472900
Aims: The aims of this investigation were to evaluate the efficacy of regular inhaled beclomethasone in the control of symptoms and lung function with non-asthmatic smoking related obstructive pulmonary disease and to evaluate the relationship between clinical responses to a short course of oral prednisone and longer term outcomes using inhaled steroid. Methods: The study was a randomised, double blind, placebo controlled, crossover investigation in 18 patients. The active treatment was inhaled beclomethasone 1000 mu-g given twice daily for three months by metered dose inhaler. At the end of each treatment period. patients received oral prednisone 30 mg/day for ten days. The two treatment phases were separated by a one month washout interval. Peak flow rates, symptom scores and "rescue" bronchodilator use were recorded twice daily. Lung function (FEV-1, FVC and lung volumes) and bronchial hyperresponsiveness (PC-20 methacholine) were measured at monthly visits. The number of exacerbations requiring intervention therapy were also recorded. Results: There were no consistent benefits attributable to beclomethasone. Lung function was not significantly better as a result of active treatment. Sputum production improved but other symptom scores were similar during active and placebo therapy. Three patients exhibited an increase in FEV-1 of 15% or more during active treatment but did not do so when oral prednisone was administered immediately after the period of placebo treatment. A further three patients showed an improvement in FEV-1 of 15% or more with oral prednisone but failed to improve during treatment with inhaled beclomethasone. The predictive value of the "trial of steroid" was 0% and 81.3% for positive and negative outcomes respectively. Conclusions: Our results indicate that in non-asthmatic chronic obstructive pulmonary disease inhaled corticosteroid fails to achieve significant improvements in either lung function or symptoms. The response to a "trial of steroid" using oral prednisone is not clinically helpful in selecting the small number of patients who may subsequently benefit from this form of therapy.