The Response of Patients with "Idiopathic" Obstructive Pulmonary Disease and "Allergic" Obstructive Bronchitis to Prednisone

Abstract

In a controlled study 18 patients with "idiopathic" obstructive lung disease and a long history of cigarette smoking and 14 with "allergic" obstructive bronchitis (bronchial asthma) were placed on ephedrine sulfate and isoproterenol aerosol. After 7 days prednisone was added. As a group, subjects with active "allergic" obstructive bronchitis showed significant improvement in ventilatory function after prednisone (P = 0.01). The overall response was also significantly greater in this group than in those with "idiopathic" obstructive lung disease after bronchodilators ( P = 0.05 ) and after prednisone ( P = 0.005 ). Although no overall improvement was noted in the "idiopathic" obstructive lung disease group after prednisone, 6 of the 18 subjects noted improvement in spirometrie values. Our data suggest that steroid responsiveness was associated with an atopic component in these individuals. There were no early complications from steroid therapy in any of the 32 subjects although follow-up studies showed exudative pericarditis in one individual who was maintained on low-dose prednisone and died 4 months after the study was completed. We believe that a brief trial of corticoids is justified in patients with clinically diagnosed "idiopathic" chronic obstructive lung disease if obstruction does not remit with conventional bronchodilators alone provided that frequent objective, as well as subjective, assessment is made.