| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS | REGISTER |
|
|
|
|
|||||||||||||
|
|
|||||||||||||||
CHRONIC OBSTRUCTIVE PULMONARY DISEASE |
1 Birmingham Heartlands Hospital, Bordesley Green East, Birmingham B9 5SS, UK
2 University Hospital Aintree, Liverpool L9 7AL, UK
3 St George’s Hospital Medical School, London SW17 0RE, UK
4 GlaxoWellcome Research and Development, Stockley Park West, Middlesex, UK
Correspondence to:
Correspondence to:
Professor P S Burge, Birmingham Heartlands Hospital, Bordesley Green East, Birmingham B9 5SS, UK;
sherwood.burge{at}heartsol.wmids.nhs.uk
Background: A trial of corticosteroids has been recommended for all patients with chronic obstructive pulmonary disease (COPD), with the subsequent "response" determining the treatment selected. This approach assumes that patients can be reliably divided into responder and non-responder groups. We have assessed whether such a separation is statistically valid, which factors influence the change in forced expiratory volume in 1 second (FEV1) after prednisolone, and whether the prednisolone response predicts 3 year changes in FEV1, health status, or number of exacerbations during placebo or fluticasone propionate treatment.
Methods: Oral prednisolone 0.6 mg/kg was given for 14 days to 524 patients with COPD before randomised treatment for 3 years with fluticasone propionate or placebo. Factors relating to change in FEV1 after prednisolone were investigated using multiple regression. The response to prednisolone was entered into separate mixed effects models of decline in FEV1 and health status during the 3 years of the study.
Results: The post-bronchodilator FEV1 increased by a mean 60 ml (CI 46 to 74) after prednisolone with a wide unimodal distribution. Current smoking was the factor most strongly associated with the change in FEV1 after prednisolone, with an increase of 35 ml in current smokers and 74 ml in confirmed ex-smokers (p<0.001). There was no relationship between the change in FEV1 after prednisolone and the response to inhaled bronchodilators, baseline FEV1, atopic status, age, or sex. The response to prednisolone, however expressed, was unrelated to the subsequent change in FEV1 over the following 3 years on either placebo or fluticasone propionate. Regression to the mean effects explained much of the apparent prednisolone response. The significant effect of treatment on decline in health status was not predicted by the prednisolone response.
Conclusion: Patients with COPD cannot be separated into discrete groups of corticosteroid responders and non-responders. Current smoking reduces the FEV1 response to prednisolone. Prednisolone testing is an unreliable predictor of the benefit from inhaled fluticasone propionate in individual patients.
Keywords: chronic obstructive pulmonary disease; prednisolone
Relevant Article
Thorax 2003 58: 647.
This article has been cited by other articles:
|
|
 |
|
  K. F. Rabe, W. Timmer, A. Sagkriotis, and K. Viel Comparison of a Combination of Tiotropium Plus Formoterol to Salmeterol Plus Fluticasone in Moderate COPD Chest, August 1, 2008; 134(2): 255 - 262. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. Braganza, R. Chaudhuri, and N. C. Thomson Review: Treating patients with respiratory disease who smoke Therapeutic Advances in Respiratory Disease, April 1, 2008; 2(2): 95 - 107. [Abstract] [PDF]
|
|
|
|
 |
|
 S. Suissa, R. McGhan, D. Niewoehner, and B. Make Inhaled Corticosteroids in Chronic Obstructive Pulmonary Disease Proceedings of the ATS, October 1, 2007; 4(7): 535 - 542. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. F. Rabe, S. Hurd, A. Anzueto, P. J. Barnes, S. A. Buist, P. Calverley, Y. Fukuchi, C. Jenkins, R. Rodriguez-Roisin, C. van Weel, et al. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease: GOLD Executive Summary Am. J. Respir. Crit. Care Med., September 15, 2007; 176(6): 532 - 555. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N. Roche Where current pharmacological therapies fall short in COPD: symptom control is not enough Eur. Respir. Rev., September 1, 2007; 16(105): 98 - 104. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Meguro, E. A. Barley, S. Spencer, and P. W. Jones Development and Validation of an Improved, COPD-Specific Version of the St. George Respiratory Questionnaire Chest, August 1, 2007; 132(2): 456 - 463. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. P. Walker, P. Mitchell, F. Diamantea, C. J. Warburton, and L. Davies Effect of primary-care spirometry on the diagnosis and management of COPD Eur. Respir. J., November 1, 2006; 28(5): 945 - 952. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
O. Leclerc, V. Lagente, J-M. Planquois, C. Berthelier, M. Artola, T. Eichholtz, C. P. Bertrand, and F. Schmidlin Involvement of MMP-12 and phosphodiesterase type 4 in cigarette smoke-induced inflammation in mice Eur. Respir. J., June 1, 2006; 27(6): 1102 - 1109. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Leigh, M. M. M. Pizzichini, M. M. Morris, F. Maltais, F. E. Hargreave, and E. Pizzichini Stable COPD: predicting benefit from high-dose inhaled corticosteroid treatment Eur. Respir. J., May 1, 2006; 27(5): 964 - 971. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Saha, R. Siva, C. E. Brightling, and I. D. Pavord COPD: an inhaled corticosteroid-resistant, oral corticosteroid-responsive condition. Eur. Respir. J., April 1, 2006; 27(4): 863 - 865. [Full Text] [PDF]
|
|
|
|
 |
|
 D D Sin, L Wu, J A Anderson, N R Anthonisen, A S Buist, P S Burge, P M Calverley, J E Connett, B Lindmark, R A Pauwels, et al. Inhaled corticosteroids and mortality in chronic obstructive pulmonary disease Thorax, December 1, 2005; 60(12): 992 - 997. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C E Brightling, S McKenna, B Hargadon, S Birring, R Green, R Siva, M Berry, D Parker, W Monteiro, I D Pavord, et al. Sputum eosinophilia and the short term response to inhaled mometasone in chronic obstructive pulmonary disease Thorax, March 1, 2005; 60(3): 193 - 198. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N.C. Thomson, R. Chaudhuri, and E. Livingston Asthma and cigarette smoking Eur. Respir. J., November 1, 2004; 24(5): 822 - 833. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. F. Donohue and J. A. Ohar Effects of Corticosteroids on Lung Function in Asthma and Chronic Obstructive Pulmonary Disease Proceedings of the ATS, November 1, 2004; 1(3): 152 - 160. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D.-W. Perng, H.-Y. Huang, H.-M. Chen, Y.-C. Lee, and R.-P. Perng Characteristics of Airway Inflammation and Bronchodilator Reversibility in COPD: A Potential Guide to Treatment Chest, August 1, 2004; 126(2): 375 - 381. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N.S. Hopkinson, W.D-C. Man, M.J. Dayer, E.T. Ross, A.H. Nickol, N. Hart, J. Moxham, and M.I. Polkey Acute effect of oral steroids on muscle function in chronic obstructive pulmonary disease Eur. Respir. J., July 1, 2004; 24(1): 137 - 142. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. R. Sutherland and R. M. Cherniack Management of Chronic Obstructive Pulmonary Disease N. Engl. J. Med., June 24, 2004; 350(26): 2689 - 2697. [Full Text] [PDF]
|
|
|
|
|
|
A. D. D'Urzo and P. M. A. Calverley Withdrawal of Treatment in the ISOLDE Study Chest, June 1, 2004; 125(6): 2368 - 2368. [Full Text] [PDF]
|
|
|
|
|
|
P M A Calverley Breathlessness during exercise in COPD: how do the drugs work? Thorax, June 1, 2004; 59(6): 455 - 457. [Full Text] [PDF]
|
|
|
|
|
|
N. A. Molfino Genetics of COPD Chest, May 1, 2004; 125(5): 1929 - 1940. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
I D Pavord, R Siva, C E Brightling, P S Burge, P M A Calverley, P W Jones, and S Spencer Prednisolone response in patients with COPD * Authors' reply Thorax, February 1, 2004; 59(2): 179 - 179. [Full Text] [PDF]
|
|
|
|
|
|
P S Burge and S A Lewis So inhaled steroids slow the rate of decline of FEV1 in patients with COPD after all? Thorax, November 1, 2003; 58(11): 911 - 913. [Full Text] [PDF]
|
|
|
|
|
|
N J Gross Responses to steroids and bronchodilators in COPD in the ISOLDE trial: the fat lady sings on Thorax, August 1, 2003; 58(8): 647 - 648. [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS | REGISTER |
