THE EFFECT OF INHALED GLUCOCORTICOSTEROIDS IN EMPHYSEMA DUE TO ALPHA(1)-ANTITRYPSIN DEFICIENCY

Despite the success of inhaled steroids in controlling asthma, the ben efit in patients with chronic obstructive pulmonary disease (COPD) rem ains controversial. Five subjects with moderate to severe emphysema du e to alpha(1)-antitrypsin deficiency (phenotype PiZ) were followed wit h daily home spirometry in a 2 x 8 weeks, randomized double-blind, pla cebo-controlled, crossover study of inhaled budesonide 0.8 mg b.i.d. I n three of the five patients, there was a statistically significant in crease in the mean forced expiratory volume in 1 s (FEV1), and in two of these patients, there was also a statistically significant increase in the mean forced vital capacity (FVC) during budesonide treatment. A significant diurnal variation in FEV1 and FVC was found in three and two patients, respectively, but did not change significantly during t reatment. These findings emphasize the need for renewed evaluation of inhaled steroids in the treatment of patients with emphysema, and indi cate that individual patients may have significant clinical improvemen t.