THE INFLUENCE OF AN INHALED STEROID ON QUALITY-OF-LIFE IN PATIENTS WITH ASTHMA OR COPD

Relatively little is known about the influence of inhaled corticostero ids on general well-being (quality of life) in patients with asthma or COPD. In a 4-year prospective controlled study, we examined the influ ence of beclomethasone dipropionate (BDP), 400 mu g, two times daily, on quality of life in 56 patients with asthma or COPD in comparison wi th the effects of BDP on symptoms and lung function. During the first 2 years, patients received only bronchodilator therapy with salbutamol or ipratropium bromide. During the third and fourth years, additional treatment with BDP was given. Fifty-six patients (28 with asthma, 28 with COPD) with an annual decline in the forced expiratory volume in 1 s (FEV(1)) of at least 80 mL/yr in combination with at least two exac erbations per year during bronchodilator therapy alone participated. Q uality of life was assessed at the start and after 2 and 4 years by me ans of the Inventory of Subjective Health (ISH) and the Nottingham Hea lth Profile (NHP). Although BDP significantly improved the course of l ung function (FEV(1)) (p<0.0001), it did not improve the ISH score or the six dimensions of the NHP neither in asthma nor in COPD. Beclometh asone dipropionate temporarily decreased respiratory symptoms during m onths 4 to 6 of BDP treatment in patients with asthma (p<0.01) and dur ing months 7 to 12 in patients with COPD (p<0.05). A weak correlation was found both cross-sectionally and longitudinally between (change in ) symptoms and quality of life on the one hand, and the (change in) FE V(1) on the other. It was concluded that BDP did not improve the gener al wellbeing of patients with asthma or COPD as measured by these gene ric health instruments. However, BDP significantly improved the course of lung function and temporarily decreased the severity of symptoms. It seems probable that changes in quality of life would have been bett er detected by use of a disease-specific health instrument. Such an in strument was not available at the start of the study. Another possible explanation for these observations is that patients soon get used to different levels of lung function and learn to live with their disease . It is advised that disease-specific health instruments are used in f uture intervention studies and that quality of life is measured freque ntly during the early phase of the intervention, eg, once every month.