Intended for healthcare professionals


Randomised, double blind, placebo controlled study of fluticasone propionate in patients with moderate to severe chronic obstructive pulmonary disease: the ISOLDE trial

BMJ 2000; 320 doi: (Published 13 May 2000) Cite this as: BMJ 2000;320:1297

Can a COPD patient of India afford high dose of inhaled Corticosteroid of Doubtful activity

Chronic Obstructive Pulmonary Disease is very common in India because
of increased habit of cigarette and ‘ bidi’ smoking. Majority of
patients take oral steroid tablets for years without realizing the
dreadful complications of corticosteroid. Moreover, less than 10% of these
patients get some symptomatic relief.

The inflammatory pattern in COPD differs markedly from that seen in
asthma, with preponderance of macrophages and CD8+ T-lymphocytes in the
airways and lung parenchyma, and an increase in macrophages and
neutrophils in sputum and bronchoalveolar lavage, in contrast to the
increase in eosinophils and activation of mast cells and CD4+ T-cells
that are characteristic of asthma . In both chronic diseases there is an
increased production of cytokines, but the pattern differs with IL-8
predominating in COPD, compared to IL-4 , IL-5 , and IL-13 in asthma. Even
high dose of corticosteroids do not suppress inflammation in COPD.

Neutrophilic inflammation which is characteristic of COPD is
resistant to corticosteroid whereas eosinophilic inflammation
characteristic of asthma is suppressed by inhaled steroids.Inhaled
corticosteroids treatment should not be routinely recommended for the
management of COPD, unless there is coexisting asthma.

Competing interests: No competing interests

23 May 2000
S K Agarwal
Department of Chest Diseases, Institute of Medical Sciences, BHU, Varanasi 221 005, India