A COMPARISON OF THE EFFECTS OF PREDNISOLONE AND MIANSERIN ON VENTILATORY, EXERCISE AND PSYCHOMETRIC PARAMETERS IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY-DISEASE

There is controversy as to whether effects on mood play a role in medi ating the response to corticosteroids in chronic obstructive pulmonary disease (COPD). If alterations in mood are important, it is conceivab le that psychotropic drugs such as mianserin might produce similar res ponses to prednisolone in patients with COPD. Twelve patients age 62.5 y, with FEV(1) 29 % of predicted and < 15 % reversibility to salbutam ol completed a randomised, double-blind crossover study. After an init ial three week placebo run-in period patients received three weeks of prednisolone 40 mg daily or mianserin 60-90 mg daily with an interveni ng three week pla cebo washout period. Full respiratory function tests , bicycle ergometry and 6 minute walks were performed before and after the run-in and at the end of each period. Psychological and functiona l assessments were also made at each visit. Prednisolone significantly increased FVC, maximum ventilation (VE(max)) and maximum heart rate ( HR(max)) compared with placebo, with mean for the difference of 0.251, 2.561 . min(-1) and 12 beats . min(-1) respectively. FVC, maximum oxy gen uptake (VO2max) and HR(max) were also significantly increased with prednisolone compared with mianserin. Anxiety scores were significant ly lower with prednisolone compared with placebo. In contrast, mianser in had no significant effects on lung function, exercise or psychologi cal parameters compared with placebo. The improvements in ventilation, exercise and anxiety scores following treatment with prednisolone wer e not reproduced by mianserin, suggesting that the effects of predniso lone in COPD are unlikely to be due to alterations in mood.