Abrupt withdrawal of inhaled corticosteroids does not result in spirometric deterioration in chronic obstructive pulmonary disease: Effect of phenotyping?

被引:10
作者
Al-Kassimi, Feisal A. [1 ]
Alhamad, Esam H. [1 ]
Al-Hajjaj, Mohammed S. [1 ]
Abba, Abdullah A. [4 ]
Raddaoui, Emad [2 ]
Shaikh, Shaffi A. [3 ]
机构
[1] King Saud Univ, Dept Med, Coll Med, Riyadh 11693, Saudi Arabia
[2] King Saud Univ, Coll Med, Dept Pathol, Riyadh 11693, Saudi Arabia
[3] King Saud Univ, Coll Med, Family & Community Med Dept, Riyadh 11693, Saudi Arabia
[4] Ahmadu Bello Univ, Dept Med, Zaria, Nigeria
关键词
Asthma; COPD; radiology and other imaging; respiratory function tests; SHORT-TERM RESPONSE; FLUTICASONE PROPIONATE; SPUTUM-EOSINOPHILIA; COPD; ASTHMA; SALMETEROL; EFFICACY; MODERATE; SAFETY; INFLAMMATION;
D O I
10.4103/1817-1737.102185
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
BACKGROUND AND OBJECTIVE: Some studies show a decline of FEV1 only one month after withdrawal of inhaled corticosteroids (ICS), while others show no decline. We speculate that the presence of an asthma phenotype in the Chronic Obstructive Pulmonary Disease (COPD) population, and that its exclusion may result in no spirometric deterioration. METHODS: We performed a prospective clinical observation study on 32 patients who fulfilled the Global Initiative for Chronic Obstructive lung disease definition of COPD (Grade II-IV). They were divided into two phenotypic groups. 1. Irreversible asthma (A and B) (n = 13): A. Asthma: Bronchial biopsy shows diffuse thickening of basement membrane (>= 6.6 mu m). B. Airflow limitation (AFL) likely to be asthma: KCO > 80% predicted if the patient refused biopsy. 2. COPD (A and B) (n = 19): A. COPD: hypercapneic respiratory failure with raised bicarbonate, panlobular emphysema with multiple bullas, or bronchial biopsy showing squamous metaplasia and epithelial/subepithelial inflammation without thickening of the basement membrane. B. AFL likely to be COPD: KCO < 80% predicted. RESULTS: The asthma phenotype was significantly younger, had a strong association with hypertrophy of nasal turbinates, and registered a significant improvement of FEV1 (350 ml) vs a decline of - 26.5 ml in the COPD phenotype following therapy with budesonide/formoterol for one year. Withdrawal of budesonide for 4 weeks in the COPD phenotype resulted in FEV1 + 1.33% (SD +/- 5.71) and FVC + 1.24% (SD +/- 5.32); a change of <12% in all patients. CONCLUSIONS: We recorded no spirometric deterioration after exclusion of the asthma phenotype from a COPD group.
引用
收藏
页码:238 / 242
页数:5
相关论文
共 47 条
[1]  
Al-Kassimi FA, 2011, ANN THORAC MED, V6, P174
[2]   Asthma Masquerading as Chronic Obstructive Pulmonary Disease: A Study of Smokers Fulfilling the GOLD Definition of Chronic Obstructive Pulmonary Disease [J].
Al-Kassimi, Feisal A. ;
Abba, Abdullah A. ;
Al-Hajjaj, Mohammed S. ;
Alhamad, Esam H. ;
Raddaoui, Emad ;
Shaikh, Shaffi Ahamed .
RESPIRATION, 2011, 82 (01) :19-27
[3]   How corticosteroids control inflammation: Quintiles prize lecture 2005 [J].
Barnes, Peter J. .
BRITISH JOURNAL OF PHARMACOLOGY, 2006, 148 (03) :245-254
[4]   Inhaled Corticosteroids in COPD: A Controversy [J].
Barnes, Peter J. .
RESPIRATION, 2010, 80 (02) :89-95
[5]   Corticosteroid resistance in chronic obstructive pulmonary disease: inactivation of histone deacetylase [J].
Barnes, PJ ;
Ito, K ;
Adcock, IM .
LANCET, 2004, 363 (9410) :731-733
[6]   Aging and disability affect misdiagnosis of COPD in elderly asthmatics - The SARA study [J].
Bellia, V ;
Battaglia, S ;
Catalano, F ;
Scichilone, N ;
Incalzi, RA ;
Imperiale, C ;
Rengo, F .
CHEST, 2003, 123 (04) :1066-1072
[7]  
Boulet L P, 1998, Can Respir J, V5, P270
[8]   Can endobronchial biopsy analysis be recommended to discriminate between asthma and COPD in routine practice? [J].
Bourdin, A ;
Serre, I ;
Flamme, H ;
Vic, P ;
Neveu, D ;
Aubas, P ;
Godard, P ;
Chanez, P .
THORAX, 2004, 59 (06) :488-493
[9]   Sputum eosinophilia and short-term response to prednisolone in chronic obstructive pulmonary disease: a randomised controlled trial [J].
Brightling, CE ;
Monteiro, W ;
Ward, R ;
Parker, D ;
Morgan, MDL ;
Wardlaw, AJ ;
Pavord, ID .
LANCET, 2000, 356 (9240) :1480-1485
[10]   Sputum eosinophilia and the short term response to inhaled mometasone in chronic obstructive pulmonary disease [J].
Brightling, CE ;
McKenna, S ;
Hargadon, B ;
Birring, S ;
Green, R ;
Siva, R ;
Berry, M ;
Parker, D ;
Monteiro, W ;
Pavord, ID ;
Bradding, P .
THORAX, 2005, 60 (03) :193-198