Corticosteroid trials in non-asthmatic chronic airflow obstruction: a comparison of oral prednisolone and inhaled beclomethasone dipropionate.

Do patients with COPD benefit from treatment with inhaled corticosteroids?

“…Most of these studies were shortterm studies, ranging from 2 weeks to 3 months [11][12][13][14][15][16][17][18][19][20]. Only a few long-term prospective studies with inhaled corticosteroids in COPD were available, ranging 12-30 months [21][22][23][24], of which one study [22] was the (24 month) follow-up of a 12 month study [21].…”

“…Most short-term studies show that inhaled steroids have beneficial effects on lung function (forced expiratory volume in one second (FEV1), forced vital capacity (FVC) and peak expiratory flow rate (PEFR)) when given in dosages of 1,500-3,000 µg beclomethasone daily for 2-6 weeks [11][12][13][14][15][16][17]. When compared with oral steroids, the effects of inhaled steroids on lung function were less pronounced [11][12][13][14][15]. Lower dosages of budesonide (800-1,600 µg) for 8 weeks to 3 months did not result in a significant improvement in lung function [18][19][20].…”

“…Airways that respond only slightly to bronchodilators after a significant decline in lung function may have some degree of damage, such as loss of lung elastic recoil, hypertrophy of airway smooth muscle and thickening of the basement membrane, which may, in some instances, not be reversed either by bronchodilators or by corticosteroids [28,29]. It is not only in long-term studies that the acute bronchodilating response has been shown to be an important predictor of Short-term studies [11] 12 Beclomethasone Double-blind/"cross-over" -FEV1 ↑, but less than with prednisone 1,600, 2 weeks comparison [12] 83 Beclomethasone Double-blind/"cross-over" -FEV1, FVC and PEFR ↑, but less than with 1,500, 2 weeks comparison prednisolone [13,14] 127 Beclomethasone Double-blind/"cross-over" -FEV1, FVC and PEFR ↑, but less than with 1,500, 2 weeks comparison prednisolone [15] 107 Beclomethasone Double-blind/"cross-over" -FEV1, FVC and PEFR ↑, but less effective 1,500, 2 weeks comparison than prednisone in emphysema [16] 105 the long-term response to inhaled steroids. In short-term studies with systemic corticosteroids in patients with COPD, a significant relationship was also found between the bronchodilating response and the response to steroids [30][31][32].…”

“…It is possible that bronchial hyperresponsiveness in COPD does not signify inflammation as it does in asthma, but is rather an expression of the degree of existing airway obstruction [38,39]. In none of the COPD studies could any influence of inhaled steroids on bronchial hyperresponsiveness (assessed by means of PC20) be observed [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25]; whilst in all of the asthma studies, a significant reduction of bronchial hyperresponsiveness was shown [5][6][7][21][22][23]. It seems probable that the inflammation in COPD is less responsive to inhaled corticosteroids than it is in asthma.…”

Costs and effects of inhaled corticosteroids and bronchodilators in asthma and chronic obstructive pulmonary disease.

“…As far as we know, this is the first prospective longitudinal economic evaluation of long-term respiratory drug use. Recent studies have shown that corticosteroids achieve beneficial effects in asthmatic patients (11)(12)(13)(14)(15)(16)(17), but there is less unanimity about the effects of corticosteroids in patients with COPD (18)(19)(20)(21). No long-term effects of anticholinergics are known.…”