Corticosteroids in chronic airways obstruction: can the patient's assessment be ignored?

In a study to examine the methods of assessing the response of patients with chronic airways obstruction to corticosteroids, 20 patients received a week of placebo tablets, followed by three weeks of prednisolone 30 mg daily. Subjective benefit was assessed by a visual analogue scale (VAS), and objective changes by spirometry and an exercise test. Significant increases in FEV1 and in exercise performance were observed after steroid therapy. Changes in FVC correlated both with VAS score and with changes in exercise performance. Changes in FEV1 correlated with neither. The good correlation between the changes in a ventilatory function test (the FVC) and the patients' assessments of the drug suggests that the non-specific euphoriant effect of steroids does not eclipse their specific action on ventilatory function. Assessment of benefit should include a subjective assessment and changes in FVC and exercise performance. Changes in FEV1 appear to have less clinical relevance.