Efficacy of inhaled steroids in undiagnosed subjects at high risk for COPD: results of the detection, intervention, and monitoring of COPD and asthma program.
OBJECTIVE
COPD leads to a progressive decline of pulmonary function. Family physicians treat a substantial number of patients with COPD and are encouraged to start treatment at as early a stage as is possible. This study analyzed the effectiveness of early inhaled corticosteroid treatment on the decline of pulmonary function in COPD patients.


METHODS
Subjects with a rapid decline in lung function (ie, FEV(1) decline, > 80 mL/yr) who had never before received a diagnosis of asthma or COPD.


METHODS
Two-year, randomized, controlled, double-blind clinical trial of fluticasone propionate (250 microg bid; 24 patients) or placebo (25 patients), followed by a 7-month open-label study in which all subjects received fluticasone propionate. The primary outcome was the post-bronchodilator therapy FEV(1,) and secondary outcomes were respiratory symptoms, exacerbations, health state, quality of life, and health-care utilization.


RESULTS
After 31 months, there were no statistical differences in post-bronchodilator therapy FEV(1) between the intervention group and the control group. No statistical differences were observed for symptoms, exacerbations, or quality of life, although tendencies were consistently in favor of treatment. There was no significant impact on the direct or indirect costs.


CONCLUSIONS
There are no indications that early treatment with inhaled corticosteroids modifies a rapid decline in lung function or respiratory symptoms and quality of life.
Albers
Mieke
M
University Medical Center, Department of Family Medicine [229-HAG], PO Box 9101, 6500 HB Nijmegen, the Netherlands. M.Albers@hag.umcn.nl
Schermer
Tjard
T
van den Boom
Guido
G
Akkermans
Reinier
R
van Schayck
Constant
C
van Herwaarden
Cees
C
van Weel
Chris
C
D000280:Administration, Inhalation; D000730:Androstadienes / Q000008:administration & dosage*; D001993:Bronchodilator Agents / Q000008:administration & dosage*; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D005260:Female; D000068298:Fluticasone; D005541:Forced Expiratory Volume / Q000187:drug effects; D006296:Health Services / Q000706:statistics & numerical data; D006304:Health Status; D006801:Humans; D008168:Lung / Q000503:physiopathology*; D008297:Male; D036501:Metered Dose Inhalers; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D011788:Quality of Life; D012307:Risk Factors
D000730:Androstadienes; D001993:Bronchodilator Agents; D000068298:Fluticasone