0
Clinical Investigations: ASTHMA |

Initial Improvements in Lung Function and Bronchial Hyperresponsiveness Are Maintained During 5 Years of Treatment With Inhaled Beclomethasone Dipropionate and Terbutaline*

W. Rob Douma, PhD; Huib A. M. Kerstjens, PhD; Ad de Gooijer, MD; Shelley E. Overbeek, PhD; Gerard H. Koëter, PhD; Dirkje S. Postma, PhD; the Dutch Chronic Nonspecific Lung Disease Study Group
Author and Funding Information

Affiliations: *From the Department of Pulmonology (Drs. Douma, Kerstjens, Koëter, and Postma), University Hospital Groningen, Groningen; the Intensive Care Unit (Dr. de Gooijer), Hospital Gelderse Vallei, Ede; and the Department of Pulmonology (Dr. Overbeek), University Hospital Rotterdam, Rotterdam, the Netherlands. ,  A complete list of participants is given in the Appendix.

Correspondence to: Dirkje S. Postma, PhD, University Hospital Groningen, Department of Pulmonology, Hanzeplein 1, 9713 GZ Groningen, the Netherlands


Affiliations: *From the Department of Pulmonology (Drs. Douma, Kerstjens, Koëter, and Postma), University Hospital Groningen, Groningen; the Intensive Care Unit (Dr. de Gooijer), Hospital Gelderse Vallei, Ede; and the Department of Pulmonology (Dr. Overbeek), University Hospital Rotterdam, Rotterdam, the Netherlands. ,  A complete list of participants is given in the Appendix.


Chest. 2002;121(1):151-157. doi:10.1378/chest.121.1.151
Text Size: A A A
Published online

Objectives: Treatment with inhaled corticosteroids reduces bronchial hyperresponsiveness and relieves airways obstruction in patients with asthma. Up to now, it is unknown whether initial improvements are maintained over a long period of time. Therefore, we assessed whether initial improvements in FEV1, provocative concentration of histamine causing a 20% fall in FEV1 (PC20), and peak expiratory flow (PEF) persist with a constant dose of inhaled corticosteroids. Furthermore, we investigated whether FEV1, PC20, PEF indexes, and symptom scores improve after increasing the dose of inhaled corticosteroids in patients who did not respond sufficiently to treatment with beclomethasone dipropionate (BDP), 800 μg/d.

Methods: Sixty-eight patients with bronchial hyperresponsiveness and airways obstruction completed a previous study on 3 years of treatment with terbutaline, 500 μg qid, and BDP, 200 μg qid. Fifty-eight of these patients participated in the current extension of another 2.5 years of follow-up. Every 6 months, FEV1 and PC20 were measured. Five patients dropped out of the study, one for pulmonary reasons. Forty-four patients continued treatment with BDP, 800 μg/d (BDP-800 group), and 9 patients received a higher dose of BDP (500 μg tid; BDP-1,500 group) after the first 3 years because of a rapid decline in FEV1 (> 50 mL/yr) despite BDP treatment during the previous study period.

Results: After the initial improvement, the mean slope of individual regression lines for FEV1, PC20, and morning PEF were − 28 mL/yr,− 0.01 doubling concentrations per year, and 0.6 L/min/yr, respectively, in the BDP-800 group. In the BDP-1,500 group, there were no statistically significant improvements in FEV1, PC20, PEF indexes, and symptom scores after increasing the dose of BDP.

Conclusions: We conclude that initial improvements in FEV1, PC20, and PEF are well preserved over 5 years in patients with obstructive airways diseases who are treated with terbutaline and BDP. In the patients who responded sufficiently to 800 μg/d of BDP, there was no accelerated decline in FEV1 compared with the general population. Increasing the dose of BDP in a small group of patients with an accelerated fall in FEV1 (initially treated with a moderate dose of BDP) resulted in no significant improvement in FEV1, PC20, PEF indexes, and symptom scores.

Figures in this Article

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
PubMed Articles
Guidelines
Long-term management of asthma.
Finnish Medical Society Duodecim | 1/11/2008
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543