Inhaled fluticasone propionate reduced exacerbations in patients with moderate to severe chronic obstructive pulmonary disease (COPD), in a study reported last week (British Medical Journal 2000;320:1297). Treatment with the steroid (500µg twice daily) also significantly reduced the rate of decline in health status (health-related quality of life), but had no effect on the rate of decline of forced expiratory volume in one second (FEV1), although small improvements were seen compared with placebo.
The data come from the inhaled steroids in obstructive lung disease in Europe (ISOLDE) trial and are reported by Dr P. Burge (consultant chest physician, Birmingham Heartlands hospital) and colleagues. The trial took place in the UK and involved 751 current or former smokers with a mean FEV1 of 50 per cent of the predicted normal. The patients were aged between 40 and 75 years and had non-asthmatic COPD.
The researchers say that inhaled steroids have been used widely in the UK for the empirical treatment of symptomatic COPD but that evidence to support the practice has been limited. They say that their findings on reduced exacerbations and rate of decline in health status "provide a rationale for the current practice of using inhaled steroids, at this dose, in patients with moderate to severe COPD".
Commenting on the study, Dr Neil Barnes (consultant respiratory physician, London Chest hospital) told The Journal on May 16 that there were four well performed studies using inhaled steroids in COPD, which included two studies using inhaled budesonide in patients with mild to moderate disease (the Copenhagen lung study [Lancet 1999;353:1819] and Euroscop [New England Journal of Medicine 1999; 340:1948]) and two studies involving fluticasone, including the ISOLDE trial. The budesonide studies gave negative results. However, Dr Barnes said that he thought that it was the severity of the disease, rather than the change in drug, that was making the difference in the results. Although the ISOLDE study was positive, the effect seen was not large and was far less than that seen in asthma patients. Dr Barnes further commented that there was really no indication for using inhaled steroids in mild to moderate COPD but he suggested that they should be used in patients with more severe disease.

Study supports the use of inhaled steroids in patients with moderate to severe COPD