Response to add-on inhaled corticosteroids in COPD based on airway hyperresponsiveness to mannitol
Chest,  Clinical Article

Scherr A et al. – In subjects with mild to moderate COPD and airway hyperresponsiveness to mannitol, quality of life and airway responsiveness improved after treatment with inhaled corticosteroids added to long–acting bronchodilator therapy.

Methods
  • Ninety subjects with mild to moderate COPD were recruited and 68 subsequently randomised in a double–blind manner to receive inhaled budesonide (1600 mcg/day, n= 31) or placebo (n= 37) for 3 months.
  • Thirty–eight subjects had airway hyperresponsiveness to mannitol (17 received budesonide, 21 placebo).
  • All subjects received tiotropium throughout the study including 4 weeks before randomisation.
  • Spirometry, quality of life (St George Respiratory Questionnaire), degree of dyspnoea, airway responsiveness to mannitol and exhaled nitric oxide were assessed at week 0 (recruitment), week 4 (baseline prior to randomisation) and week 16 (posttreatment).

Results
  • Compared to placebo, budesonide was associated with improved quality of life in subjects showing airway hyperresponsiveness to mannitol (difference of changes in quality of life score between randomisation and study completion: –9.1, 95% CI [–15.8; –2.3] p< 0.01).
  • Treatment with inhaled budesonide also led to a reduction in airway responsiveness to mannitol compared with the placebo group (difference in log response–dose–ratio change: –0.3 95% CI [–0.6;–0.04] p< 0.01).
  • However, post – randomisation changes in FEV1 % predicted, quality of life and nitric oxide showed no difference between budesonide and placebo.

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