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Our interpretation of the important data on corticosteroid responsiveness in chronic obstructive pulmonary disease (COPD) presented by Burge et al1 is quite different from that of the authors. They have shown that those with an improvement in forced expiratory volume in 1 second (FEV1) of >20% following short term treatment with prednisolone had a more significant reduction in exacerbation frequency with longer term treatment with inhaled fluticasone than those without. Thus, arguably, the only important positive clinical outcome of long term treatment of COPD with inhaled corticosteroids is largely confined to those who are identified by a positive response to prednisolone. This is a powerful validation of the suggestion in current guidelines2 that decisions on …
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