Corticosteroids
Oral or inhaled corticosteroids, on account of their anti-inflammatory properties, are very useful in ascertaining the maximum achievable level of FEV1 in a patient. After all, if the bronchodilator effect of a shortacting drug appears to be limited, this might be due to airway inflammation. Unless the effects of corticosteroids are assessed one is uncertain to what extent this component can be effectively redressed [ref. 1]. Hence a brief course of oral corticosteroids or a high dose of inhaled corticosteroids is the final piece in assessing the reversibility of airway obstruction [ref. 2].
Effective treatment with corticosteroids improves the level of FEV1, and this affects the response to shortacting bronchodilators (view experimental data in the animation). It also attenuates the maximal airway narrowing that may occur on exposure to bronchoconstricting agents, so that anti-inflammatory treatment diminishes the risk of lifethreatening bronchoconstriction [ref. 3].
| Ref. 1 - Variability in bronchodilator responsiveness within subjects | |
| Kerstjens HAM, Brand PLP, Quanjer PhH, van der Bruggen-Bogaerts BAHA, Koëter GH, Postma DS, and the Dutch CNSLD Study Group. Variability of bronchodilator response and effects of inhaled corticosteroid treatment in obstructive airways disease. Thorax 1993; 48: 722-729. | |
| Ref. 2 - Recommendations with regard to a short course with corticosteroids are as follows: | |
| American Thoracic Society (1995): | |
| in COPD prednisone 40 mg (or 0.5 mg/kg) daily for 10-14 days. | |
| no recommendation on inhaled corticosteroids. | |
| European Respiratory Society (1995): | |
| in COPD 0.4-0.6 mg/kg daily for 2-4 weeks. | |
| no recommendation on inhaled corticosteroids. | |
| Dutch General Practitioners (1997): | |
| when COPD is suspected COPD 30 mg prednisone daily for 2 weeks, or | |
| budesonide or beclomethasone 800 µg daily for 2 weeks or | |
| fluticasone 500 µg for 2 weeks. | |
| British Thoracic Society (1997) | |
| prednisolone 30 mg daily for 2 weeks or | |
| inhaled corticosteroid, e.g. beclomethasone 500 µg twice a day, or | |
| equivalent drug, for 6 weeks. | |
| Ref. 3 - Attenuated bronchoconstrictor response | |
| Bel EH, Timmers MC, Dijkman JH, Sterk PJ. The effect of inhaled corticosteroids on the maximal degree of airway narrowing to methacholine in asthmatic subjects. Am Rev Respir Dis 1991; 143: 109-111. | |