Intended for healthcare professionals

Rapid response to:


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

Rapid Response:

Critical reading exercise

Since the topic of this paper is important in primary care, and its
methods, results and conclusions clearly presented, I thought that it
might make an interesting subject for a tutorial on critical reading with
my GP Registrar. A more than normally careful scrutiny made me realise
how much I must miss in my usual scanning of the BMJ. I would like to
raise three points (having already read previous e-responses to the
article which cover others).

1. The diagnostic criteria chosen differ from those currently
recommended by the B.T.S.; the latter do not refer to FEV1 after
bronchodilatation, and mild COPD is defined as 60-79% predicted, compared
to 85% in the article. What is the rationale behind these criteria?

2. Table 2, under FEV1 after bronchodilator refers to Predicted FEV1
at 3 months and 3 years: should this read "Mean FEV1" or have I

3. The finding that an oral steroid trial does not predict response
to an inhaled steroid not only runs counter to the current guidelines
which recommend such a trial, but surely demands more discussion than it
is accorded.

Finally, I share other commentators concerns at the side-effects such
as hoarseness and bruising, and the doubtful cost-benefit given the high
cost of inhaled fluticasone and the relatively minor reduction in
exacerbations on treatment.

All the same, I thank the authors for prompting me to spend an hour
in analytical mode instead of on automatic pilot!

Dougal Jeffries

Competing interests: No competing interests

03 June 2000
Dougal Jeffries