© 2003 BMJ Publishing Group & British Thoracic Society
EDITORIAL
Responses to steroids and bronchodilators in COPD
Responses to steroids and bronchodilators in COPD in the ISOLDE trial: the fat lady sings on
Hines VA Hospital, Stritch-Loyola School of Medicine, Chicago, IL 60141, USA; Nicholas.gross@med.va.gov
Two new findings using data from the ISOLDE trial are presented in this issue of Thorax: (1) patients with COPD cannot be separated into discrete corticosteroid responders and non-responders, and (2) the response of an individual patient with COPD to a bronchodilator challenge on a single occasion does not predict whether or not the patient will benefit subsequently from that agent. Consistency is needed between North America and Europe as to the diagnosis of COPD and the criteria for inclusion in COPD trials.
Keywords: chronic obstructive pulmonary disease; corticosteroids; bronchodilators
| The first 150 words of the full text of this article appear below. |
The main results of the ISOLDE trial have been published1 and are now part of the canon of knowledge about COPD—inhaled corticosteroids (ICS) do not change the rate of decline of FEV1 in COPD. This finding is consistent with that of other similar large long term trials,2–4 so the question has been settled. As in some of the other studies, there may be decreases in the frequency and severity of acute exacerbations, and quality of life may be modestly improved. These questions are being addressed in separate ongoing long term trials.
Despite the rule that the primary and secondary outcomes of a trial must be prestated and set in stone in the protocol, trials such as ISOLDE are so large and so carefully planned, executed, and monitored that the huge amounts of data they generate offer many opportunities to examine questions other than
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