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Long-term inhaled steroid response testing should be done in heterogeneous COPD-population
- Niels H Chavannes, Tjard RJ Schermer, on behalf of the COOPT Study Group (31 July 2003)
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Niels H Chavannes, Researcher and primary care physician Caphri Research Institute, Department of General Practice, Maastricht University, Tjard RJ Schermer, on behalf of the COOPT Study Group
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niels.chavannes{at}hag.unimaas.nl Niels H Chavannes, et al.
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Dear Editor These clinically important papers [1,2] by the Isolde researchers provide excellent data questioning the rationale behind inclusion of patients in the large COPD-studies that have been reported in past few years. Selection of patients on the basis of absence of reversibility means ruling out the easiest measurable variable that may correlate with steroid response. When assessing effects of two weeks prednisolone, or the value of reversibility as a determinant of long-term treatment response to inhaled steroids, one should bear in mind that the Isolde population does not represent the typical patient with COPD that primary care physicians encounter in daily practice. In primary care, one finds all degrees of reversibility, both mild, moderate and indeed some severe COPD, some with and some without significant response. Although highly relevant, the results of the two Isolde papers represent only moderate to severe COPD in absence of reversibility. Therefore, Gross is very right in his editorial to state that we should be openminded about the future; the COOPT-Study which is currently conducted in the Netherlands (Europe) consciously dismissed reversibility as an entry criterion and recruited its population in primary care.[3] Similar to Isolde we performed the two weeks' pretreatment with prednisolone before randomisation and will look at reversibility as a determinant for inhaled steroid response. Results will be available next year, and then we can finally widen our focus to include the field of primary care as well. Don't worry about the fat lady; she will be back. References (1) Burge PS, Calverley PMA, Jones PW, et al. Prednisolone response in patients with chronic obstructive pulmonary disease: results from the ISOLDE study. Thorax 2003;58:654–8. (2) Calverley PMA, Burge PS, Spencer A, et al. Bronchodilator reversibility testing in chronic obstructive pulmonary disease. Thorax 2003;58:659–64. (3) Chavannes NH, Schermer TRJ, Wouters EF, Van Weel C, Van Schayck CP. Treatment of COPD in general practice: the COOPT study. Eur Respir J 2001;18(Suppl 33):348S. |
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