Asthma and chronic obstructive pulmonary disease (COPD) : aspects of treatment with inhaled corticosteroids of patients with mild signs or a clinical diagnosis

摘要

Treatment of patients with (mild signs of) asthma or COPD with inhaled corticosteroids was the central theme of the research in this thesis. Part One of the thesis contains original data from the DIMCA study, a large general-practice-based study on Detection, Intervention, and Monitoring of patients with mild signs of COPD and Asthma. Several aspects of early intervention with the relatively new inhaled corticosteroid fluticasone propionate {Flixotide©, 500 microgram daily) in patients with mild signs of asthma or COPD without a clear diagnosis were investigated, such as 'fear of corticosteroids' (Chapter 2), clinical effects (Chapter 3) and compliance of treatment (Chapter 4). The main conclusion of this part of the thesis was that the experimental treatment with fluticasone propionate (500 microgram daily) did not improve lung function in subjects with mild signs of COPD during two years of treatment or patients with mild signs of asthma during one year of treatment. In Part Two related questions are presented concerning the dosage and duration of treatment with inhaled corticosteroids in patient with diagnosed mild asthma (Chapter 5 and 6) and in patients with diagnosed moderate to severe COPD (Chapter 7 and 8). This resulted in the following main conclusion: in contrast to the results of recent large international trials in our study high dosages of inhaled corticosteroids (1500/1600 microgram daily) during two years of study seemed to improve lung function a little in patients with moderate COPD