Langdurige behandeling met inhalatiesteroïden heeft gunstig effect bij matig ernstige COPD*

OBJECTIVE : To determine if long-term treatment with inhaled steroids (ICS), both with and without long-acting β2-agonists (LABA) reduces inflammation and improves pulmonary function in COPD. DESIGN : Randomized placebo-controlled trial in two Dutch centres (http://clinicaltrials.gov/ct2/show/NCT00158847). METHODS : 114 steroid-naïve patients with moderate to severe COPD (smokers or ex-smokers) were treated double-blind with: (n = 26) fluticasone propionate 500 µg twice daily (bid) for 6 (n = 31) or 30 months, or with fluticasone 500 µg bid and salmeterol 50 µg bid (n = 28) for 30 months, or with placebo bid (n = 29). Primary outcomes were the cell counts of bronchial biopsies and sputum. Airway hyper-responsiveness was measured before randomisation and at 6 and 30 months; clinical outcomes were determined every 3 months. RESULTS : A total of 101 patients were > 70% adherent to therapy. After 6 months of fluticasone use the lymphocyte (CD3+, CD4+, and CD8+) and mast cell count in the airway wall decreased (only p <0.005) and the hyper-responsiveness improved (p