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Early Steroids Treatment Might Not Arrest Lung Function Decline In Obstructive Airway Disease: Presented at ERS

By Cameron Johnston

Special to DG News

BERLIN, GERMANY -- September 25, 2001 -- Early use of inhaled corticosteroids does not appear to arrest the decline in lung function among symptomatic patients with obstructive airflow disease.

Results of the small study, which were presented today (September 25) at the annual meting of the European Respiratory Society, in Berlin, Germany, suggest that more aggressive treatments will be required in newly diagnosed individuals, if the loss of lung function is to be halted.

The study, conducted in the Netherlands, by Dr. Mieke Albers and colleagues, of the department of general practice at the University Medical Centre of St. Radboud, in Nijemgen, The Netherlands, involved 49 people who had recently been diagnosed with obstructive airway disease who showed a decline in forced expiratory volume in one second (FEV₁) of more than 200 mL per year.

Twenty-four subjects received the inhaled corticosteroid (fluticasone propionate, 250 mg b.i.d.) and another 25 received placebo for two years, followed by a seven-month open label extension study in which all subjects received the steroid.

Outcome measurements, taken every six months, included lung function, reversibility and bronchial hyperresponsiveness (BHR), symptoms, atopy, allergy, exacerbations, health-related quality of life, functional status, smoking behavior, work disability and health care cost.

There were no statistically significant differences in changes to FEV₁ between groups at any point during the entire study period.

"Overall, between the groups we found no difference in the course of lung function decline," Dr. Albers said in her presentation. "Therefore, we have to conclude that based on lung function parameters, there is no convincing scientific evidence that early use of inhaled corticosteroids alters the long-term prognosis of subjects with a rapid decline in lung function."

Dr. Albers stopped short of recommending that inhaled steroids be withheld from patients who are already taking them, saying that lung function represents only one measurement parameter. Other parameters such as the number of exacerbations, quality of life, airway symptoms, and functional status still need to be evaluated, she said.

The study was controlled for the small numbers, and for its short duration, she said, "but when we look at our figures, we are looking at just one very small part of the picture" and lung function is far from being the only consideration to bear in mind when treating chronic obstructive pulmonary disease.

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