1. RESPONSE TO ADD-ON INHALED CORTICOSTEROIDS IN COPD BASED ON AIRWAY HYPERRESPONSIVENESS TO MANNITOL Andreas Scherr, MD ; Salome Schafroth Török, MD ; Anja Jochmann, MD ;David Miedinger, MD ; Sabrina Maier, RN ; Anne B. Taegtmeyer, MBBS, PhD ;Prashant N. Chhajed, MBBS, MD, FCCP ; Michael Tamm, MD, FCCP ;and Joerg D. Leuppi, MD, PhD CHEST. October 2012;142(4):919-926. doi:10.1378/chest.11-2535 R1 최하나

2. Introduction  COPD  chronic airflow limitation that is not fully reversible.  progressive decline in lung function over time.  Clinical and functional presentations vary greatly among patients, even when degrees of airflow limitation are similar.  The development of COPD : chronic airway & systemic inflammation.  Asthma : ICSs are very effective in controlling symptoms and disease severity  COPD : the antiinflammatory properties of ICSs remain controversial  High doses of ICSs is expensive and carries the risk of reduced bone density and other side effects, including pneumonia.  Therefore, the identification of subgroups likely to benefit from ICS treatment would be helpful.

3. Materials and Methods age≥35year GOLD class I & II Tiotropium + budesonide 800ug bid Tiotropium + placebo Miflonide 400ug capsule (Novartis)

4. Result  Subject characteristics

5. Result  Baseline and postrandomization

6. Result  Outcome Differences in Budesonide-Treated Compared With Placebo-Treated Subjects

7. Result  Effect of Budesonide According to Airway Responsiveness to Mannitol

8. Discussion  Well-matched, randomized, placebo-controlled trial  The results suggest  AHR often is present in patients with COPD  treatment with ICS is associated with a significant improvement in quality of life and reduction in airway responsiveness to mannitol.  Current COPD GOLD guidelines recommend initiating treatment with long-acting bronchodilators prior to commencing add-on ICS.  The study aim was to investigate whether airway responsiveness to mannitol predicts response to add-on ICS treatment.

9. Discussion  Limitation  The dropout rate of 24% was relatively high. - not introduce bias because it was equal in both study arms.  Lack of data for sputum eosinophilia - AHR to mannitol is associated with sputum eosinophilia, it can be further hypothesized that ICS reduces an underlying eosinophilic Inflammation.

10. Conclusion  mild to moderate COPD  AHR to mannitol → Improvement in quality of life and reduction of airway responsiveness to mannitol after 3 months treatment with ICS.  Therefore, the present study provides evidence that the presence of AHR to mannitol identifies patients with mild to moderate COPD who are likely to respond to antiinflammatory medication, and mannitol testing in mild to moderate COPD might be useful in selecting patients for ICS treatment.