Predictive value and utility of oral steroid testing for treatment of COPD in primary care: the COOPT study

Niels H Chavannes1,2, Tjard RJ Schermer3, Emiel FM Wouters4, Reinier P Akkermans3, Richard PN Dekhuijzen5, Jean WM Muris2, Chris van Weel3, Onno CP van Schayck21Department of Public Health and Primary Care, Leiden University Medical Center, The Netherlands; 2Caphri Research Institute, Department of General Practice, Maastricht University, The Netherlands; 3Department of Primary and Community Care, Radboud University Nijmegen Medical Center, The Netherlands; 4Department of Pulmonary Diseases, University Hospital Maastricht, The Netherlands; 5Department of Pulmonary Diseases, Radboud University Nijmegen Medical Center, The NetherlandsBackground: The oral prednisolone test is widely used to distinguish chronic obstructive pulmonary disease (COPD) patients who might benefit from inhaled steroid treatment. Previous studies used selected patient groups that did not represent the large COPD population in primary care.Methods: The study included smokers and exsmokers with chronic bronchitis or COPD from primary care, who underwent prednisolone testing (30 mg for 14 days) before randomization in a three-year follow-up randomized controlled trial (COOPT Study). Spirometry was performed before and after the test. Responders and nonresponders were classified according to international criteria. Effectiveness of inhaled fluticasone relative to placebo was compared in terms of health status (Chronic Respiratory Disease Questionnaire), exacerbations, and postbronchodilator forced expiratory volume in one second (FEV1), using repeated measurement analysis.Results: Two hundred eighty-six patients recruited from 44 primary care practices were randomized. Nine percent to 16% of the COPD population was classified as responder, depending on the international guideline criteria used. On average, responders did not reach the minimum clinically important difference in health status (0.29 points/year, P = 0.05), although a borderline significant effect of inhaled fluticasone was noted. Possible clinically relevant reductions in exacerbation rate (rate ratio 0.67) and FEV1 decline (39 mL/year) occurred in responders, but did not reach statistical significance.Conclusions: Oral steroid testing identifies a limited proportion of COPD patients, but does not reveal any clinically relevant benefit from inhaled steroid treatment on health status. No significant effects on exacerbation rate and lung function decline occurred.Keywords: COPD, primary care, oral steroid testing, prednisolone tes