Steroid Response in Stable Chronic Obstructive Pulmonary Disease

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Abstract
A 2-wk course of 32 mg/day methylprednisolone was compared with placebo in a double-blind crossover trial in 46 well-characterized patients with stable chronic obstruction pulmonary disease. Placebo and steroid trials were separated by 2 wk when no tablets were given. Responses were assessed by measuring forced expiratory volume in 1 s (FEV1.0). Placebo responses were normally distributed (mean, 0.8% change in FEV1.0; range, -30-33%). Six patients showed a > 50% increase of FEV1.0 in response to steroid; a 7th showed a 36% increase and an 8th, a 29% increase. Because of these patients the group as a whole showed a significantly greater FEV1.0 after steroid than after placebo. The 8 steroid responders did not differ from nonresponders in age, sex, smoking history or duration and intensity of symptoms including wheeze. Baseline lung function and eosinophilia of blood or sputum did not differ between the 2 groups. Patients who responded to steroids also responded to inhaled .beta.- agonists: Acute bronchodilator response averaged 25% in steroid responders and 13% in nonresponders, a statistically significant difference although there was overlap between the 2 groups.