THE EFFICACY OF INHALED CORTICOSTEROIDS IN THE MANAGEMENT OF MON ASTHMATIC CHRONIC AIR-FLOW OBSTRUCTION

Aims. The aims of this investigation were to evaluate the efficacy of regular inhaled beclomethasone in the control of symptoms and lung fun ction with non-asthmatic smoking related obstructive pulmonary disease and to evaluate the relationship between clinical responses to a shor t course of oral prednisone and longer term outcomes using inhaled ste roid. Methods. The study was a randomised, double blind, placebo contr olled, crossover investigation in 18 patients. The active treatment wa s 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 ph ases were separated by a one month washout interval, Peak flow rates, symptom scores and ''rescue'' bronchodilator use were recorded twice d aily. Lung function (FEV1, FVC and lung volumes) and bronchial hyperre sponsiveness (PC20 methacholine) were measured at monthly visits, The number of exacerbations requiring intervention therapy were also recor ded. Results. There were no consistent benefits attributable to beclom ethasone. Lung function was not significantly better as a result of ac tive treatment. Sputum production improved but other symptom scores we re similar during active and placebo therapy. Three patients exhibited an increase in FEV1 of 15% or more during active treatment but did no t do so when oral prednisone was administered immediately after the pe riod of placebo treatment. A further three patients showed an improvem ent in FEV1, 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 o utcomes respectively. Conclusions. Our results indicate that in non-as thmatic chronic obstructive pulmonary disease inhaled corticosteroid f ails to achieve significant improvements in either lung function or sy mptoms. The response to a ''trial of steroid'' using oral prednisone i s not clinically helpful in selecting the small number of patients who may subsequently benefit from this form of therapy.