Randomised, double blind, placebo controlled study of fluticasone propionate in patients with moderate to severe chronic obstructive pulmonary disease: the ISOLDE trial
Support for the widespread practice of using high dose inhaled corticosteroids in patients with moderate to severe chronic obstructive pulmonary disease (COPD ) which affects lung function comes in this week's BMJ in a paper by Burge et al.
COPD occurs predominantly in tobacco smokers and is a leading cause of illness and death world-wide. As lung function deteriorates (measured by forced expiratory volume - FEV ) substantial changes in general health occur. Dr Peter Burge and colleagues report on the ISOLDE trial in which 18 UK hospitals took part involving 751 patients who were current or former smokers. The men and women were aged between 40 and 75 years.
The ISOLDE trial (Inhaled Steroids in Obstructive Lung Disease study) looked not only at FEV levels measuring lung function, but at the general health status of the patients. The study shows for the first time that, like FEV, health status declines at a measurable rate in patients with severe to moderate COPD. The use of an inhaled steroid called Fluticasone propionate at high doses significantly reduced the rate of this decline in health status. The use of the steroid also resulted in fewer "exacerbations" - a worsening of respiratory symptoms requiring additional treatment. No benefit of fluticasone propionate on the rate of decline in FEV was found.
"These data provide a rationale for the current practice of using inhaled corticosteroids at this dose in patients with moderate to severe COPD" states the BMJ paper.
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