Steroid reversibility test followed by inhaled budesonide or placebo in outpatients with stable chronic obstructive pulmonary disease

The aim of this study was evaluate the predictive value of a 2 week course of prednisolone on the effect of 6 months treatment with inhaled budesonide in patients with stable chronic obstructive pulmonary disease (COPD). Forty patients with stable COPD entered the study, and received prednisolon e (37.5 mg o.d.) for 2 weeks. They were subsequently divided into steroid-i rreversible and steroid-irreversible, using 15% of baseline as a dividing p oint. In each group patients were randomized to receive budesonide 400 mu g b.i.d. or placebo for 6 months: During treatment with prednisolone, three patients dropped out because of s ide effects. Of the remaining 37, only two patients (5%) were reversible wi th prednisolone forced expiratory volume in Is [(FEV1) > 15% of baseline], and among the steroid-irreversible, 26 patients were evaluated after 6 mont hs treatment with either placebo or budesonide. No significant differences in spirometry values, symptoms, or number of exacerbations were found betwe en these two groups. Reversibility with prednisolone is rarely seen in COPD. In outpatients with stable COPD,and no signs of asthma or atopy, 2 weeks treatment with predni solone seems to be of no value in choosing subsequent long-term therapy. (C ) 1999 HARCOURT PUBLISHERS LTD.