BMJ 2000;321:1349 ( 25 November )

Letters

The ISOLDE trial

    Side effects with inhaled steroids should not be forgotten
    Side effects are source of concern
    Pharmaceutical companies should admit high cost of treatment

Side effects with inhaled steroids should not be forgotten

The first 150 words of the full text of this article appear below.

EDITOR---Burge et al in the ISOLDE study have shown a small but significant improvement in clinical outcomes with high dose inhaled fluticasone in patients with chronic obstructive pulmonary disease, without influencing the decline in lung function.1 Their recommendation for using high dose inhaled steroids needs to be tempered on the basis of their potential for producing systemic adverse effects, especially in susceptible elderly patients.

In the ISOLDE study there was a significant but small degree of adrenal suppression, as shown by 11% and 14% falls in serum concentrations of cortisol measured at 8-10 am after six and 24 months of fluticasone compared with no change in the placebo group. Spot measurement of cortisol concentrations at 8-10 am is extremely insensitive at detecting adrenal suppression,2 which makes the finding of any significant fall even more relevant as a surrogate marker for potential systemic bioactivity in these patients. This is supported by . . . [Full text of this article]
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Relevant Article

Randomised, double blind, placebo controlled study of fluticasone propionate in patients with moderate to severe chronic obstructive pulmonary disease: the ISOLDE trial
P S Burge, P M A Calverley, P W Jones, S Spencer, J A Anderson, and T K Maslen
BMJ 2000 320: 1297-1303. [Abstract] [Full Text] [PDF]

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