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ARTICLE

Slowing the Deterioration of Asthma and Chronic Obstructive Pulmonary Disease Observed during Bronchodilator Therapy by Adding Inhaled Corticosteroids: A 4-Year Prospective Study

Edward Dompeling; Constant P. van Schayck; Petrus M. van Grunsven; Cees L. A. van Herwaarden; Reinier Akkermans; Johan Molema; Hans Folgering; and Chris van Weel

15 May 1993 | Volume 118 Issue 10 | Pages 770-778

Objective: To determine if deterioration in patients with asthma or chronic obstructive pulmonary disease (COPD) during bronchodilator therapy could be slowed by additional treatment with an inhaled corticosteroid.

Design: A 4-year prospective study.

Setting: Twenty-nine general practices in the catchment area of the University of Nijmegen, Nijmegen, the Netherlands.

Patients: The study included 56 patients (28 with asthma and 28 with COPD) who showed an annual decrease in the forced expiratory volume in 1 second (FEV₁) of at least 80 mL in combination with at least two exacerbations per year during bronchodilator therapy alone. Forty-eight patients completed the study.

Intervention: During the first 2 years of treatment, patients received only bronchodilator therapy (salbutamol, 400 µg, or ipratropium bromide, 40 µg). During years 3 and 4, they received additional treatment with beclomethasone dipropionate, 400 µg two times daily.

Results: Prebronchodilator FEV₁ increased 458 mL/y (95% CI, 233 to 683 mL/y) during the first 6 months of beclomethasone treatment; FEV₁ then decreased 102 mL/y (CI, 57 to 147 mL/y) during months 7 to 24. The annual decline in FEV₁ during beclomethasone treatment was less than the decline of 160 mL/y seen before beclomethasone therapy (difference, 58 mL/y; 95% CI, 2 to 87 mL/y). Only in patients with asthma did beclomethasone treatment improve bronchial hyper-responsiveness (assessed by determining the concentration of histamine that provoked a 20% decrease in FEV₁ [PC₂₀]) by 3.0 doubling doses per year (95% CI, 0.8 to 5.2 doses per year). Beclomethasone treatment was associated with improvement in peak expiratory flow rate, alleviation of symptoms, and a decrease in the number of exacerbations in both patient groups.

Conclusion: Adding beclomethasone, 800 µg daily, slowed the unfavorable course of asthma or COPD seen with bronchodilator therapy alone. This effect was most evident in asthmatic patients.

Author and Article Information

From the University of Nijmegen, Nijmegen, the Netherlands.
Requests for Reprints: Edward Dompeling, MD, Department of Family Medicine, University of Nijmegen, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.
Acknowledgments: The authors thank L. Bierman and A. Raaymakers for doing the pulmonary function and bronchial hyper-responsiveness measurements; and P. Mulder and H.J.M. van den Hoogen for giving statistical advice.
Grant Support: In part by grants from the Dutch Asthma Foundation (numbers 86.28 and 88.35), Glaxo BV (Zeist, The Netherlands), and Boehringer Ingelheim BV (Alkmaar, the Netherlands).

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