title: Addition of inhaled corticosteroids to systemic immunosuppression after lung transplantation: a double-blind, placebo-controlled trial.
abstract: BACKGROUND
  It is postulated that bronchiolitis obliterans syndrome (BOS) is preceded by airway inflammation that has been described even in stable lung transplant recipients. Airway inflammation is known to be suppressed by inhaled steroids in other chronic inflammatory lung diseases, e.g., asthma and chronic obstructive pulmonary disease. BOS is the major cause of morbidity and mortality after lung transplantation.
  
  
  OBJECTIVE
  To examine the effect of inhaled corticosteroids on the development of BOS in lung transplant recipients.
  
  
  METHODS
  Thirty patients were recruited and randomized in a double-blind fashion to receive either 750 microg of fluticasone propionate (FP) or an identical-appearing placebo twice daily for 3 months; 20 of this group continued until 2 years posttransplantation. Detailed spirometry was performed regularly throughout the study.
  
  
  RESULTS
  In the short-term study no differences were found in any examined parameters. In the long-term component of the study no differences were found in the development of neither BOS nor survival. There were minor differences in bronchoalveolar lavage (BAL) lymphocyte percentages.
  
  
  CONCLUSIONS
  FP is ineffective for the prevention of BOS after lung transplantation despite the airway inflammation that characterizes this condition. Inadequate local delivery, timing of the therapy relative to transplantation and inherent steroid resistance of this condition may explain the negative finding of this study.
authors.affiliation: Department of Respiratory Medicine, The Alfred Hospital, Commercial Road, Prahran, Victoria, Australia 3181.
authors.forename: Helen
authors.initials: H
authors.lastname: Whitford
authors.forename: E Haydn
authors.initials: EH
authors.lastname: Walters
authors.forename: Bronwyn
authors.initials: B
authors.lastname: Levvey
authors.forename: Tom
authors.initials: T
authors.lastname: Kotsimbos
authors.forename: Bernadette
authors.initials: B
authors.lastname: Orsida
authors.forename: Chris
authors.initials: C
authors.lastname: Ward
authors.forename: Michael
authors.initials: M
authors.lastname: Pais
authors.forename: Sue
authors.initials: S
authors.lastname: Reid
authors.forename: Trevor
authors.initials: T
authors.lastname: Williams
authors.forename: Greg
authors.initials: G
authors.lastname: Snell
mesh_terms: D000280:Administration, Inhalation; D000328:Adult; D000730:Androstadienes / Q000008:administration & dosage*; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D001989:Bronchiolitis Obliterans / Q000175:diagnosis / Q000188:drug therapy / Q000517:prevention & control*; D018893:Bronchoalveolar Lavage; D001999:Bronchoscopy; D018572:Disease-Free Survival; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D000068298:Fluticasone; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000188:drug therapy / Q000517:prevention & control
chemical_list: D000730:Androstadienes; D000893:Anti-Inflammatory Agents; D007166:Immunosuppressive Agents; D000068298:Fluticasone