A comparison of oral and inhaled steroids in patients with chronic airways obstruction: features determining response.

Abstract

Harding, S. M., and Freedman, S. (1978). Thorax, 33,[214][215][216][217][218]. A comparison of oral and inhaled steroids in patients with chronic airways obstruction: features determining response. Two trials comparing aerosol and oral steroid treatment were carried out in patients with chronic airways obstruction. All patients had a history of chronic productive cough and an FEV1 less than 70% predicted but did not have episodic or seasonal breathlessness with wheezing. One trial involved 18 outpatients, the other 18 inpatients. Both studies involved three consecutive treatment periods, the first with placebo aerosol, the second with active aerosol (betamethasone valerate, 800 ug/day), and the third with oral prednisone or prednisolone (30 mg/day). Six patients showed a significant improvement in ventilatory capacity on steroids. Initial assessment included a comprehensive history using a questionnaire, skin tests, blood and sputum eosinophil counts, and chest radiography. In addition, for the inpatients, response to isoprenaline, daily sputum volume, and Paco2 were measured. Only blood eosinophilia and variability in ventilatory capacity during the placebo period seemed indicative of a likely response to steroids. However, there was a large overlap between various features on assessment in the responders and non-responders, and the management of every patient with chronic airways obstruction should include a controlled trial of steroids. The steroid aerosol produced a good improvement in ventilatory capacity in the responsive patients who were hospitalised and this was thought to be helped by supervision of aerosol technique. Such an aerosol could therefore be used for a steroid trial although oral steroids were found to give a more definitive response.

The response to inhaled and oral steroids in patients with stable chronic obstructive pulmonary disease

“…Therefore, long-term administration of inhaled steroids, which carry with them a relative low systemic steroid effect, may be attractive in the treatment of stable COPD patients. In recent years, several studies [3,[9][10]12] have demonstrated the efficacy of inhaled steroids taken with good technique, at least in a proportion of COPD patients. In addition, our studies suggest that only 20-25% of stable COPD patients will respond to inhaled steroids, but the rate of response is about 75% when inhaled steroids are administered to patients whose airway resistance is significantly decreased following ␤ 2 -agonist inhalation.…”

“…Steroid responsiveness of a patient with COPD may lead to improvement in airflow rate and a better quality of life. However, only a minority of patients with COPD have a favourable response to corticosteroids [9][10][11][12], and, in addition, the benefit of corticosteroid treatment may be outweighed by the side-effects of the drug [13,14]. Therefore, long-term administration of inhaled steroids, which carry with them a relative low systemic steroid effect, may be attractive in the treatment of stable COPD patients.…”

“…In several studies [5,7], corticosteroid responders also showed a response to inhaled bronchodilators. However, certain others [9,11] have shown a failure of ␤ 2 -agonist reversibility to predict steroid response. The most likely factor to account for some studies finding positive correlation while others found no correlation between steroids and ␤ 2 -agonist responders would seem to be the characteristics of the patient population studied.…”

“…However, previous studies performed by us [3] and by others [4][5][6][7] have shown, with objective measurements of improved airflow, rates of response to corticosteroids of about 25% in stable COPD patients. Because of the serious adverse effect of a long course of oral corticosteroid treatment, inhaled steroids became attractive as a means of treatment in asthma [8], and more recently also in patients with COPD [9][10][11][12]. However, most of the studies compared varied aerosolized beclomethasone dipropionate dosages to oral prednisone or prednisolone and reported a greater effect of the oral drugs [11].…”

A comparison of the effects of prednisolone and mianserin on ventilatory, exercise and psychometric parameters in patients with chronic obstructive pulmonary disease

“…Some studies assessing the shortterm use of oral and inhaled steroids have shown improvements in spirometry, walking distance and general well being in a proportion of patients, whilst others have found no convincing benefit [3][4][5][6][7][8][9].…”