Intermitterende versus continue behandeling met geïnhaleerde corticosteroïden bij chronische obstructieve longziekten
01 / 1999 - 12 / 2003
At present there is no cure for COPD, yet its mortality and morbidity are increasing worldwide. Recent studies have shown that inhaled corticosteroids improve lung function for 3-6 months, which is maintained throughout the following 2.5 years without further improvement. The pathophysiology underlying these changes in lung function are unsolved. The pathology of COPD is heterogeneous, with inflammation in the small airways and features of emphysema. Some of the pathological features of inflammation can be obtained from airway wall biopsies.This inflammation does not only lead to swelling and structural changes in the airway wall, but also to destruction of peribronchiolar attachments and parenchymal destruction by an imbalance of local proteases and their inhibitors. In addition, qualitative and quantitative defects in local tissue repair may contribute to the development of the pathology in COPD. lt is possible that anti-inflammatory therapy not only suppresses the acute inflammation in the airways and lung tissue, but it intervenes in tissue repair as well, thereby not only having beneficial effects, but also inhibiting repair. This study assesses the clinical, functional and pathological outcome of short- and long-term treatment with inhaled corticosteroids in patients with COPD. lt will clarify whether short-term treatment suffices or whether long-term treatment is mandatory to preserve these benefits. Since add-on therapy with long-acting beta-agonists in combination with inhaled corticosteroids is very effective in asthma, we also address this issue in a three-year follow-up.