Bronchodilators and Corticosteroids in Chronic Bronchitis and Emphysema

Abstract

The breathing capacity of 26 patients suffering from chronic bronchitis and emphysema was measured, during remission from acute infection, by timed spirometry, and expressed in terms of forced excretory volume/second (F.E.V.1.) The extent of spontaneous change over a mean period of 1 month was measured. The greatest F.E.V.s exceeded the smallest by 20% in 7 cases out of 26. Inhalation of isoprenaline sulphate aerosol yielded a rise in F.E.V. of 5 to 47% (mean 21%). An increase of over 25% occurred in one-third of the patients. The percentage increase tended to be greater the more depressed a patient''s F.E.V. was below expected values, though some of those with depressed F.E.V.s responded poorly. Patients'' subjective assessment of response to isoprenaline was fairly good. Prednisolone given orally yielded a small non-significant rise (mean 5.8%) in the whole series. Although patients suffering from asthma were excluded, 6 patients gave a personal or family history suggestive of allergy, and in these there was a mean rise of 25%. In the remaining 20 patients the mean response was zero. It is difficult to predict on clinical grounds which chronic bronchitics will respond to corticosteroids and which will not. Patients'' subjective assessment of response was poor and often misleading. It is therefore desirable to measure any change occurring with corticosteroids by an objective test of expiratory capacity. Owing to the extent of spontaneous change in F.E.V. that can occur, it is essential to make several measurements during a period of treatment and to precede these by several measurements during a preliminary control period.