A double blind, randomised, placebo controlled, crossover trial of prednisolone (40 mg/day for 14 days) was carried out in 33 patients with chronic airflow limitation (mean age 62 years, mean FEV1 101 litres, mean FEV1/FVC ratio 44%), to assess the value of serial peak expiratory flow (PEF) measurements, taken five times daily in evaluating treatment response by comparison with other objective measurements and with measurements of symptoms. The mean serial PEF after a one week run in period was 189 1 min-, during the second week of placebo 193 1 min-1, and during the second week on prednisolone 231 1 min-1. The difference in mean PEF values between placebo and prednisolone was significant (p < 0 01). With regard to the response to steroids of the individual patients, 13 of the 33 had a detectable trend of improvement on visual inspection of serial PEF measurements during prednisolone treatment but only one during placebo administration. Of all the objective measurements made after the run in and after each treatment phase (12 minute walking distance, FEV1, forced vital capacity (FVC), serial PEF), the serial PEF chart provided the best discrimination between placebo and prednisolone treatment. There was no statistically significant association between steroid induced improvement in serial PEF measurements and in breathlessness, partly because of placebo improvements in symptoms in those who had no improvement in serial PEF values. This study indicates the importance of making objective measurements to identify a genuine steroid response rather than relying on symptomatic improvement alone. The best simple measurement to make is serial PEF during steroid trials. This is more sensitive in detecting a steroid response than are the 12 minute walking distance, FEV1, or FVC, and is also less likely than these measurements to show spurious placebo responses.Serial peak expiratory flow (PEF) Accepted 16 December 1985 chronic airflow limitation than in asthmatic patients, and may also be less than the natural diurnal variation seen in these patients over a period of time.4The present study was done to assess the value of serial PEF measurements in patients with chronic airflow limitation during a double blind crossover controlled trial of oral corticosteroids when compared with changes in symptoms and with other commonly used objective measurements of response. MethodsWe studied 33 (26 male) patients aged (mean 61-7) years with moderate to severe chronic airflow limitation (mean FEV1/forced vital capacity (FVC)) ratio 44%, 58% predicted. The mean FEV1 was 1-011 (36% -predicted;-range 0-44-1-77%) and the mean FVC was 2-291(63% predicted). All patients had had 606 on 10 May 2018 by guest. Protected by copyright.

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Corticosteroids may produce mood changes. This could account for improvement in patients with chronic airflow limitation following trials of oral corticosteroid treatment as mood elevation might improve performance in objective measurements. This proposition was tested in 21 patients with chronic airflow limitation, who underwent detailed psychological assessment during a randomised controlled double blind crossover trial of the effect of prednisolone 40 mg daily compared with that of a placebo. Self rating visual analogue scales for various qualities of mood were completed before the study and after each phase in addition to depression and psychological symptom questionnaires. After treatment with the placebo, patients showed increases in cheerfulness (p < 0.01) and sociability (p < 0.01) and a decrease in depression (p <0.01). After treatment with prednisolone there were increases in cheerfulness (p < 0.01), optimism (p < 0.01), activity (p < 0.05), and sociability (p < 0.02) and there was a decrease in depression (p < 0.01). When placebo and prednisolone values were compared, however, there were no significant differences. Some patients showed improvements (>20%) in peak expiratory flow, FEV, or forced vital capacity (FVC) after prednisolone, but nearly all had improvements in at least one psychological test. There were no detectable associations between changes in objective measurements and changes in psychological test ratings. This study suggests that in patients with chronic obstructive lung disease significant psychological changes are no more likely to follow treatment with a corticosteroid than treatment with a placebo and that physiological improvement after corticosteroid treatment is not tied to psychological changes.

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