Document Detail


Periodic treatment regimens with inhaled steroids in asthma or chronic obstructive pulmonary disease. Is it possible?
MedLine Citation:
PMID:  7596005     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To determine whether inhaled corticosteroids can be discontinued in the stable phase of asthma or chronic obstructive pulmonary disease (COPD) or if this therapy should be continued.
DESIGN: Nonrandomized open uncontrolled 5-year trial.
SETTING: Prospective study in general practice.
PATIENTS: Forty-eight patients with steroid-dependent asthma or COPD who had shown a decline in forced expiratory volume in 1 second (FEV1) of at least 80 mL per year and at least one exacerbation per year during the first 2 years of bronchodilator treatment. Subjects were treated additionally with inhaled steroids for another 2 years and were finally given the option to stop using steroids. Sixteen patients were willing to stop using beclomethasone and were studied for another year. No recruitment bias took place in this consecutive sample in the fifth year of follow-up. Two of 16 patients developed carcinomas and dropped out.
INTERVENTIONS: Two years of bronchodilator treatment alone (400 micrograms of salbutamol or 40 micrograms of ipratropium bromide four times daily), followed by 2 years of additional inhaled corticosteroid treatment (400 micrograms of beclomethasone two times daily), and finally 1 year of bronchodilator treatment alone.
MAIN OUTCOME MEASURES: Decline in lung function (FEV1), change in bronchial hyperresponsiveness, indicated by a provocative concentration of histamine causing a 20% fall in FEV1 (PC20), morning peak expiratory flow rate (PEFR), diurnal PEFR, week-to-week variation of PEFR, bronchial symptoms, and exacerbations.
RESULTS: The course of FEV1 during the year in which beclomethasone was discontinued was not significantly different when compared with the 2-year period of beclomethasone treatment. Neither did the course of PC20, morning PEFR, diurnal PEFR, symptom score, and exacerbation rate change. Only the week-to-week variation of the PEFR increased after discontinuing steroids.
CONCLUSIONS: Discontinuing inhaled steroids is possible in some patients with asthma or COPD after 2 years of regular treatment. This might indicate that for certain groups of patients with mild asthma or COPD, periodic treatment schedules with inhaled steroids is the treatment policy for the future.
Authors:
C P van Schayck; P J van den Broek; J J den Otter; C L van Herwaarden; J Molema; C van Weel
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Publication Detail:
Type:  Clinical Trial; Journal Article    
Journal Detail:
Title:  JAMA     Volume:  274     ISSN:  0098-7484     ISO Abbreviation:  JAMA     Publication Date:  1995 Jul 
Date Detail:
Created Date:  1995-07-31     Completed Date:  1995-07-31     Revised Date:  2014-09-17    
Medline Journal Info:
Nlm Unique ID:  7501160     Medline TA:  JAMA     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  161-4     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
Administration, Inhalation
Asthma / drug therapy*,  physiopathology
Beclomethasone / administration & dosage,  therapeutic use*
Bronchodilator Agents / administration & dosage,  therapeutic use
Drug Administration Schedule
Drug Therapy, Combination
Female
Follow-Up Studies
Glucocorticoids / administration & dosage,  therapeutic use
Humans
Lung Diseases, Obstructive / drug therapy*,  physiopathology
Male
Middle Aged
Prospective Studies
Respiratory Function Tests
Time Factors
Chemical
Reg. No./Substance:
0/Bronchodilator Agents; 0/Glucocorticoids; KGZ1SLC28Z/Beclomethasone

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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