A comparison of oral and inhaled steroids in patients with chronic airways obstruction: features determining response.

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Abstract
Two trials comparing aerosol and oral steroid treatment were carried out in patients with chronic airways obstruction. All patients had a history of chronic productive cough and an FEV1 [forced expiratory volume in 1 s] less than 70% predicted but did not have episodic or seasonal breathlessness with wheezing. One trial involved 18 outpatients, the other 18 inpatients. Both studies involved 3 consecutive treatment periods, the 1st with placebo aerosol, the 2nd with active aerosol (betamethasone valerate, 800 .mu.g/day), and the 3rd with oral prednisone or prednisolone (30 mg/day). Six patients showed a significant improvement in ventilatory capacity on steroids. Initial assessment included a comprehensive history using a questionnaire, skin tests, blood and sputum eosinophil counts and chest radiography. In addition, for the inpatients, response to isoprenaline, daily sputum volume and PaCO2 [partial pressure of arterial CO2] were measured. Only blood eosinophilia and variability in ventilatory capacity during the placebo period seemed indicative of a likely response to steroids. There was a large overlap between various features on assessment in the responders and non-responders, and the management of every patient with chronic airways obstruction should include a controlled trial of steroids. The steroid aerosol produced a good improvement in ventilatory capacity in the responsive patients who were hospitalized and this was probably helped by supervision of aerosol technique. Aerosols could be used for a steroid trial although oral steroids gave a more definitive response.