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Is It Possible?

Constant P. van Schayck, PhD; Paul J. J. A. van den Broek, MD; Joost J. den Otter, MD; Cees L. A. van Herwaarden, MD, PhD; Johan Molema, MD, PhD; Chris van Weel, MD, PhD

JAMA. 1995;274(2):161-164.

Abstract
Objective.
—To determine whether inhaled corticosteroids can be discontinued in the stable phase of asthma or chronic obstructive pulmonary disease (COPD) or if this therapy should be continued.

Design.
—Nonrandomized open uncontrolled 5-year trial.

Setting.
—Prospective study in general practice.

Patients.
—Forty-eight patients with steroid-dependent asthma or COPD who had shown a decline in forced expiratory volume in 1 second (FEV₁) of at least 80 mL per year and at least one exacerbation per year during the first 2 years of bronchodilator treatment. Subjects were treated additionally with inhaled steroids for another 2 years and were finally given the option to stop using steroids. Sixteen patients were willing to stop using beclomethasone and were studied for another year. No recruitment bias took place in this consecutive sample in the fifth year of follow-up. Two of 16 patients developed carcinomas and dropped out.

Interventions.
—Two years of bronchodilator treatment alone (400 µg of salbutamol or 40 µg of ipratropium bromide four times daily), followed by 2 years of additional inhaled corticosteroid treatment (400 µg of beclomethasone two times daily), and finally 1 year of bronchodilator treatment alone.

Main Outcome Measures.
—Decline in lung function (FEV₁), change in bronchial hyperresponsiveness, indicated by a provocative concentration of histamine causing a 20% fall in FEV₁ (PC₂₀), morning peak expiratory flow rate (PEFR), diurnal PEFR, week-to-week variation of PEFR, bronchial symptoms, and exacerbations.

Results.
—The course of FEV₁ during the year in which beclomethasone was discontinued was not significantly different when compared with the 2-year period of beclomethasone treatment. Neither did the course of PC₂₀, morning PEFR, diurnal PEFR, symptom score, and exacerbation rate change. Only the week-to-week variation of the PEFR increased after discontinuing steroids.

Conclusions.
—Discontinuing inhaled steroids is possible in some patients with asthma or COPD after 2 years of regular treatment. This might indicate that for certain groups of patients with mild asthma or COPD, periodic treatment schedules with inhaled steroids is the treatment policy for the future.

(JAMA. 1995;274:161-164)

Author Affiliations
From Department of General Practice/Family Practice (Drs van Schayck, van den Broek, den Otter, and van Weel) and University Lung Centre Dekkerswald (Drs van Herwaarden and Molema), University of Nijmegen (the Netherlands).

Footnotes
Reprint requests to Department of General Practice/ Family Practice, University of Nijmegen, PO Box 9101, 6500 HB Nijmegen, the Netherlands (Dr van Schayck).

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