Effect of inhaled triamcinolone on the decline in pulmonary function in chronic obstructive pulmonary disease.

Background: Chronic obstructive pulmonary disease (COPD) results from a pro gressive decline in lung function, which is thought to be the consequence o f airway inflammation. We hypothesized that antiinflammatory therapy with i nhaled corticosteroids would slow this decline. Methods: We enrolled 1116 persons with COPD whose forced expiratory volume in one second (FEV1) was 30 to 90 percent of the predicted value in a 10-ce nter, placebo-controlled, randomized trial of inhaled triamcinolone acetoni de administered at a dose of 600 microg twice daily. The primary outcome me asure was the rate of decline in FEV1) after the administration of a bronch odilator. The secondary outcome measures included respiratory symptoms, use of health care services, and airway reactivity. In a substudy of 412 parti cipants, we measured bone density in the lumbar spine and femur at base lin e and one and three years after the beginning of treatment. Results: The mean duration of follow-up was 40 months. The rate of decline in the FEV1) after bronchodilator use was similar in the 559 participants i n the triamcinolone group and the 557 participants in the placebo group (me an [+/-SE], 44.2+/-2.9 vs. 47.0+/-3.0 ml per year, P=0.50). Members of the triamcinolone group had fewer respiratory symptoms during the course of the study (21.1 per 100 person-years vs. 28.2 per 100 person-years, P=0.005) a nd had fewer visits to a physician because of a respiratory illness (1.2 pe r 100 person-years vs. 2.1 per 100 person-years, P=0.03). Those taking tria mcinolone also had lower airway reactivity in response to methacholine chal lenge at 9 months and 33 months (P=0.02 for both comparisons). After three years, the bone density of the lumbar spine (P=0.007) and the femur (P<0.00 1) was significantly lower in the triamcinolone group. Conclusions: Inhaled triamcinolone does not slow the rate of decline in lun g function in people with COPD, but it improves airway reactivity and respi ratory symptoms and decreases the use of health care services for respirato ry problems. These benefits should be weighed against the potential long-te rm adverse effects of triamcinolone on bone mineral density. (N Engl J Med 2000;343:1902-9.) (C) 2000, Massachusetts Medical Society.