Prediction of treatment-response to inhaled corticosteroids by mannitol-challenge test in COPD. A proof of concept.
BACKGROUND
There are no predictors known that can identify COPD patients who will respond to treatment with ICS.


METHODS
We investigated 30 patients (median age 65 (range 44-83, 12 females) with mild to moderately severe COPD. All patients had post bronchodilator FEV1/forced vital capacity ratio of less than 70% and a reversibility of less than 12% and 200 ml from baseline. We wanted to determine if airway responsiveness (AHR) to histamine and mannitol could predict who would respond to a 3-month course of ICS.


RESULTS
At baseline, all patients had AHR to histamine, but only 7 (23%) patients to mannitol. After 3 months of treatment with ICS, there was no significant change in spirometry or the quality of life when analysing all individuals together. However, FEV1% predicted improved from 67% (IQR12) to 79% (IQR16) in mannitol positive patients; whereas it was unchanged in the mannitol negative patients. The difference in the mean change of FEV1% predicted between the two groups was 12 (IQR13.5) and this was highly significant (p=0.001). The improvement in quality of life (SGRQ 30 (IQR10.5) to 21 (IQR12; p=0.01) was only significant in the patients positive to mannitol.


CONCLUSIONS
We propose that AHR to mannitol could predict ICS-responsiveness in mild to moderately severe COPD patients.
Leuppi
Jörg D
JD
Pneumology, Department of Internal Medicine, University Hospital, Petersgraben 4, Basel CH-4031, Switzerland. jleuppi@uhbs.ch
Tandjung
Ryan
R
Anderson
Sandra D
SD
Stolz
Daiana
D
Brutsche
Martin H
MH
Bingisser
Roland
R
Perruchoud
André P
AP
Surber
Christian
C
Knoblauch
Andreas
A
Andersson
Morgan
M
Greiff
Lennart
L
Chan
Hak-Kim
HK
Tamm
Michael
M
D000280:Administration, Inhalation; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001985:Bronchial Provocation Tests; D016085:Bronchoconstrictor Agents; D001993:Bronchodilator Agents / Q000627:therapeutic use*; D019819:Budesonide / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D005260:Female; D005541:Forced Expiratory Volume / Q000502:physiology; D006632:Histamine; D006801:Humans; D008297:Male; D008353:Mannitol; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy* / Q000503:physiopathology; D011788:Quality of Life; D013147:Spirometry; D016896:Treatment Outcome; D014797:Vital Capacity / Q000502:physiology
D016085:Bronchoconstrictor Agents; D001993:Bronchodilator Agents; D008353:Mannitol; D019819:Budesonide; D006632:Histamine