The effect of inhaled corticosteroids on the development of emphysema in smokers assessed by annual computed tomography

TY - JOUR

T1 - The effect of inhaled corticosteroids on the development of emphysema in smokers assessed by annual computed tomography

AU - Shaker, Saher B

AU - Dirksen, Asger

AU - Ulrik, Charlotte S

AU - Hestad, Marianne

AU - Stavngaard, Trine

AU - Laursen, Lars C

AU - Maltbaek, Niels

AU - Clementsen, Paul

AU - Skjaerbaek, Nanna

AU - Nielsen, Lars

AU - Stoel, Berend

AU - Skovgaard, Lene T

AU - Tonnesen, Philip

AU - Shaker, Saher B

AU - Dirksen, Asger

AU - Ulrik, Charlotte S

AU - Hestad, Marianne

AU - Stavngaard, Trine

AU - Laursen, Lars C

AU - Maltbaek, Niels

AU - Clementsen, Paul

AU - Skjaerbaek, Nanna

AU - Nielsen, Lars

AU - Stoel, Berend

AU - Skovgaard, Lene T

AU - Tonnesen, Philip

N1 - Keywords: Administration, Inhalation; Aged; Aged, 80 and over; Budesonide; Double-Blind Method; Female; Forced Expiratory Volume; Glucocorticoids; Humans; Lung Volume Measurements; Male; Middle Aged; Pulmonary Emphysema; Smoking; Tomography, X-Ray Computed; Treatment Outcome

PY - 2009

Y1 - 2009

N2 - The objective was to evaluate the effect of inhaled corticosteroids on disease progression in smokers with moderate to severe chronic obstructive pulmonary disease (COPD), as assessed by annual computed tomography (CT) using lung density (LD) measurements. Two hundred and fifty-four current smokers with COPD were randomised to treatment with either an inhaled corticosteroids (ICS), budesonide 400 microg bid, or placebo. COPD was defined as FEV(1) < or = 70% pred, FEV(1)/FVC < or = 60% and no reversibility to beta(2)-agonists and oral corticosteroids. The patients were followed for 2-4 years with biannual spirometry and annual CT and comprehensive lung function tests (LFT). CT images were analysed using Pulmo-CMS software. LD was derived from a pixel-density histogram of the whole lung as the 15th percentile density (PD15) and the relative area of emphysema at a threshold of -910 Hounsfield units (RA-910), and both were volume-adjusted to predicted total lung capacity. At baseline, mean age was 64 years and 64 years; mean number of pack-years was 56 and 56; mean FEV(1) was 1.53 L (51% pred) and 1.53 L (53% pred); mean PD15 was 103 g/L and 104 g/L; and mean RA-910 was 14% and 13%, respectively, for the budesonide and placebo groups. The annual fall in PD15 was -1.12 g/L in the budesonide group and -1.81 g/L in the placebo group (p = 0.09); the annual increase in RA-910 was 0.4% in the budesonide group and 1.1% in the placebo group (p = 0.02). There was no difference in annual decline in FEV(1) between ICS (-54 mL) and placebo (-56 mL) (p = 0.89). Long-term budesonide inhalation shows a non-significant trend towards reducing the progression of emphysema as determined by the CT-derived 15th percentile lung density from annual CT scans in current smokers with moderate to severe COPD.

AB - The objective was to evaluate the effect of inhaled corticosteroids on disease progression in smokers with moderate to severe chronic obstructive pulmonary disease (COPD), as assessed by annual computed tomography (CT) using lung density (LD) measurements. Two hundred and fifty-four current smokers with COPD were randomised to treatment with either an inhaled corticosteroids (ICS), budesonide 400 microg bid, or placebo. COPD was defined as FEV(1) < or = 70% pred, FEV(1)/FVC < or = 60% and no reversibility to beta(2)-agonists and oral corticosteroids. The patients were followed for 2-4 years with biannual spirometry and annual CT and comprehensive lung function tests (LFT). CT images were analysed using Pulmo-CMS software. LD was derived from a pixel-density histogram of the whole lung as the 15th percentile density (PD15) and the relative area of emphysema at a threshold of -910 Hounsfield units (RA-910), and both were volume-adjusted to predicted total lung capacity. At baseline, mean age was 64 years and 64 years; mean number of pack-years was 56 and 56; mean FEV(1) was 1.53 L (51% pred) and 1.53 L (53% pred); mean PD15 was 103 g/L and 104 g/L; and mean RA-910 was 14% and 13%, respectively, for the budesonide and placebo groups. The annual fall in PD15 was -1.12 g/L in the budesonide group and -1.81 g/L in the placebo group (p = 0.09); the annual increase in RA-910 was 0.4% in the budesonide group and 1.1% in the placebo group (p = 0.02). There was no difference in annual decline in FEV(1) between ICS (-54 mL) and placebo (-56 mL) (p = 0.89). Long-term budesonide inhalation shows a non-significant trend towards reducing the progression of emphysema as determined by the CT-derived 15th percentile lung density from annual CT scans in current smokers with moderate to severe COPD.

U2 - 10.1080/15412550902772593

DO - 10.1080/15412550902772593

M3 - Journal article

C2 - 19378223

SN - 1541-2555

VL - 6

SP - 104

EP - 111

JO - COPD: Journal of Chronic Obstructive Pulmonary Disease

JF - COPD: Journal of Chronic Obstructive Pulmonary Disease

IS - 2

ER -