Effects of long-acting bronchodilators and prednisolone on inspiratory lung function parameters in stable COPD.
BACKGROUND
In chronic obstructive pulmonary disease (COPD), there is a poor correlation between forced expiratory volume in 1 s (FEV1) and dyspnea following bronchodilator use. Better correlations have been observed between inspiratory lung function parameters (ILPs) and dyspnea, which drives our interest in ILPs. However, the acute and prolonged effects of long-acting bronchodilators and oral corticosteroids on ILPs have not been well investigated. Therefore, the aim of this study was to investigate the effects of these treatments on the ILPs, FEV1, dyspnea (visual analog scale (VAS)) and clinical COPD questionnaire (CCQ).


METHODS
Twenty-eight stable COPD patients had their ILPs and FEV1 measured both before and 2 h after the use of a single dose of 18 mcg bronchodilator tiotropium and 50 mcg salmeterol. Thereafter, the patients were randomized to 2 weeks of treatment with 30 mg oral prednisolone once daily or oral placebo in combination with daily treatment with these two bronchodilators. Four weeks after the cessation of the randomized treatment, the ILPs and FEV1 were again measured. After each intervention, any change in the VAS score was assessed.


RESULTS
With both bronchodilators, significant improvements in ILPs were demonstrated (p < 0.005), with the exception of changes in ILPs inspiratory capacity (IC) and forced inspiratory flow at 50% of the vital capacity (FIF50) after tiotropium inhalation. After 2 weeks of treatment with prednisolone, significant differences were found for ILP forced inspiratory volume in 1 s (FIV1) and FEV1 compared with placebo. These differences were no longer present 4 weeks after the cessation of prednisolone. Significant relationships between ILPs and VAS scores were only found after 2 weeks of treatment with prednisolone or placebo.


CONCLUSIONS
After a single dose of long-acting bronchodilator salmeterol, significant improvements are observed in all ILPs and in FIV1 and PIF after tiotropium. Two weeks of oral corticosteroid treatment improved the FIV1 and FEV1. The dyspnea VAS score was only significantly correlated with the ILPs after 2 weeks of oral corticosteroid treatment.
Dept. of Pulmonology, IJsselland Ziekenhuis, Capelle a/d IJssel, The Netherlands. Electronic address: SRamlal@ysl.nl.
S K
SK
Ramlal
Dept. of Pulmonology, Canisius Wilhelmina Ziekenhuis, Nijmegen, The Netherlands.
F J
FJ
Visser
Dept. of Biostatistics, Erasmus Medical Centre, Rotterdam, The Netherlands.
W C J
WC
Hop
Dept. of Pulmonology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
P N R
PN
Dekhuijzen
Dept. of Pulmonology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
Y F
YF
Heijdra
D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D000420:Albuterol / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000494:pharmacology / Q000627:therapeutic use; D001993:Bronchodilator Agents / Q000008:administration & dosage / Q000494:pharmacology* / Q000627:therapeutic use; D003692:Delayed-Action Preparations; D004311:Double-Blind Method; D004417:Dyspnea / Q000188:drug therapy* / Q000209:etiology; D005260:Female; D005541:Forced Expiratory Volume / Q000187:drug effects; D005938:Glucocorticoids / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use; D006801:Humans; D007320:Inspiratory Capacity / Q000187:drug effects; D008297:Male; D008875:Middle Aged; D011239:Prednisolone / Q000008:administration & dosage / Q000494:pharmacology* / Q000627:therapeutic use; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy* / Q000503:physiopathology; D012129:Respiratory Function Tests; D000068299:Salmeterol Xinafoate; D012602:Scopolamine Derivatives / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use; D011795:Surveys and Questionnaires; D013997:Time Factors; D000069447:Tiotropium Bromide
D001993:Bronchodilator Agents; D003692:Delayed-Action Preparations; D005938:Glucocorticoids; D012602:Scopolamine Derivatives; D000068299:Salmeterol Xinafoate; D011239:Prednisolone; D000420:Albuterol; D000069447:Tiotropium Bromide
COPD; FEV1; FIF50; FIV1; IC; PIF