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Title
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Relapse in FEV1 Decline After Steroid Withdrawal in COPD
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Author
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Institution/Organisation
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GLUCOLD Study Grp
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Abstract
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| BACKGROUND: We previously observed that 30 months of inhaled corticosteroid (ICS) treatment can attenuate FEV1 decline in COPD, but it is unclear whether withdrawal induces a relapse. We hypothesized that FEV1 decline, airway hyperresponsiveness (AHR), and quality of life (QOL) deteriorate after ICS cessation even after prolonged use. METHODS: One hundred fourteen patients with moderate to severe COPD finished randomized 6-month or 30-month treatment with fluticasone (500 mu g bid), 30-month treatment with fluticasone and salmeterol (500/50 mu g bid), or placebo (first part of the Groningen and Leiden Universities Corticosteroids in Obstructive Lung Disease [GLUCOLD] study [GL1]). The subsequent 5 years, patients were prospectively followed annually, treated by their physician (GLUCOLD follow-up study [GL2]). Postbronchodilator FEV1, AHR, and QOL were initially recorded at baseline, at 30 months (GL1), and annually during GL2. Analysis was performed by linear mixed-effects models. RESULTS: Among 101 adherent patients during GL1, 79 patients started and 58 completed GL2. Patients using ICSs during GL1, but only using ICSs 0% to 50% of the time during GL2 (n = 56 of 79), had significantly accelerated annual FEV1 decline compared with GL1 (difference GL2-GL1 [95% CI]: 30-month treatment with fluticasone and salmeterol, -68 mL/y [-112 to -25], P = .002; 30-month treatment with fluticasone, -73 mL/y [-119 to -26], P = .002), accompanied by deterioration in AHR and QOL. CONCLUSIONS: ICS discontinuation aft er 30 months in COPD can worsen lung function decline, AHR, and QOL during 5-year follow-up. This suggests that ICS treatment lacks sustained disease-modifying effect after treatment cessation. |
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Language
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English
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Source (journal)
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Chest / American College of Chest Physicians. - Chicago, Ill., 1970, currens
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Publication
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Chicago, Ill.
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2015
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ISSN
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0012-3692
[print]
1931-3543
[online]
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DOI
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10.1378/CHEST.14-3091
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Volume/pages
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148
:2
(2015)
, p. 389-396
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ISI
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000359005700038
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Pubmed ID
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25836351
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Full text (Publisher's DOI)
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