A controlled trial of prednisone, in low dosage, in patients with chronic airways obstruction

Evans, Janice Perry; Morrison, ID; Saunders, K.B.

doi:10.1136/thx.29.4.401

Cited by 26 publications

(3 citation statements)

References 17 publications

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“…They have not previously been used in patients with 'irreversible' airways obstruction associated with chronic bronchitis, although a short report on the use of triamcinolone acetonide aerosol has indicated that some will respond to this route of corticosteroid administration (Matlin, 1976). Oral corticosteroids, however, have been used in several studies with some investigations claiming objective improvement (Franklin et al, 1958;Clifton and Stuart-Harris, 1962;Beerel et al, 1963;Freedman, 1963), some, subjective improvement only (Cullen and Reidt, 1960;Beerel and Vance, 1971), and others no benefit (Morgan and Rusche, 1964;Oppenheimer et al, 1968;Evans et al, 1974).…”

mentioning

confidence: 99%

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

Harding¹,

Freedman²

1978

Thorax

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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.

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confidence: 99%

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

Harding¹,

Freedman²

1978

Thorax

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“…16,17 The search of the Cochrane Collaboration Database of Systematic Reviews yielded 1 metaanalysis, which analyzed 7 published studies of systemic steroid administration in COPD exacerbations. 18 This meta-analysis was not included in the data extraction of this systematic review, but was reviewed because it also contained some unpublished data obtained from the authors of 3 publishedtrials.Twentyofthesepublications were not directly relevant to the study and were discarded for the following reasons: 8 trials addressed inhaled steroid preparations in COPD [19][20][21][22][23][24][25][26] ; 4 considered patients with stable COPD [27][28][29][30] ; 4 were not placebo-controlled trials [31][32][33][34] ; 1 described a study design and presented no clinical data 35 ; 1 presented data from a substudy of an included published trial 36 ; and 2 were not relevant trials of respiratory disease. 37,38 The 8 remaining double-blind, randomized, placebocontrolled trials studied either intravenous or oral corticosteroid administration in patients with acute COPD exacerbations.…”

Section: Resultsmentioning

confidence: 99%

Corticosteroid Therapy for Patients With Acute Exacerbations of Chronic Obstructive Pulmonary Disease

Singh

Palda²,

Stanbrook³

et al. 2002

Arch Intern Med

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“…Long-term studies have given controversial results with these drugs (8)(9)(10)(11), as have shortterm ones (12,27). However,the only investigation performed in CAD patients with ARF (12) reported a significant improvement in spirometric parameters after the administration of methylprednisolone as compared with placebo.…”

Section: Discussionmentioning

confidence: 95%

Acute effect of corticosteroids on respiratory mechanics in mechanically ventilated patients with chronic airflow obstruction and acute respiratory failure.

Rubini

Rampulla²,

Nava³

1994

Am J Respir Crit Care Med

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We assessed the short-term effect of steroids on respiratory mechanics in eight mechanically ventilated patients with chronic airflow obstruction (CAO) and hypercapnic respiratory failure. Airflow (V), airway pressure (Paw), and changes in pulmonary volume were measured using a conventional ventilator. End-expiratory and end-inspiratory airway occlusions were performed to assess intrinsic PEEP (PEEPi), static compliance of total respiratory system (Cstrs), maximum inspiratory resistance (Rrsmax), and minimum inspiratory resistance (Rrsmin). These parameters were recorded at control, 30 min after saline, and 90 min after steroid (methylprednisolone 0.8 mg/kg intravenous) administration. No significant changes were found in respiratory mechanics after administration of saline. Steroids induced a significant decrease (p < 0.01) in inspiratory resistance (Rrsmax from 20.3 +/- 8.6 cm H2O/L/s (control) to 15.3 +/- 6.1 (90 min) and Rrsmin from 16.2 +/- 8.0 (control) to 11.9 +/- 6.5 (90 min), with no significant reduction in Paw and Cstrs. The PEEPi, reflecting pulmonary dynamic hyperinflation, was also significantly reduced (-16% from control). We conclude that in mechanically ventilated CAO patients, steroids may be useful in improving respiratory mechanics and therefore in providing better conditions for weaning from mechanical ventilation.

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A controlled trial of prednisone, in low dosage, in patients with chronic airways obstruction

Cited by 26 publications

References 17 publications

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

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

Corticosteroid Therapy for Patients With Acute Exacerbations of Chronic Obstructive Pulmonary Disease

Acute effect of corticosteroids on respiratory mechanics in mechanically ventilated patients with chronic airflow obstruction and acute respiratory failure.

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