Methacholine challenge test as indicator for add on inhaled corticosteroids in COPD patients

BackgroundBronchial hyperreactivity (BHR) has been described in COPD. Inhaled corticosteroids (ICS) are used in the treatment of asthma, but the beneficial effects of steroid treatment in COPD are debatable. It has been suggested that inhaled corticosteroids are more likely to have beneficial effects in patients with COPD with more severe bronchial hyperresponsiveness.Aim of the workTo investigate whether airway responsiveness to methacholine predicts response to add-on ICS treatment.Subjects and methodsThe study included 50 COPD patients stage I and stage II according to GOLD classification based on lung function and reversibility test. All cases were subjected to written informed consent, through history talking and clinical examination, chest X-ray, ECG and laboratory tests and methacholine challenge test. Then all patients were assessed by pulmonary function test, Clinical COPD Questionnaire (CCQ) and modified medical research council (MMRC) dyspnea scale. We added budesonide 800 mg daily with the previous medication for 6 months then patients were reevaluated again by the same tools used in the last visit.ResultsOur study showed that among 50 COPD patients with GOLD I or GOLD II classification 24 (48%) patients were positive for methacholine challenge test. Cases with positive methacholine test showed significant improvement regarding both CCQ and MMRC dyspnea scale with ICS treatment with no significant difference between both groups regarding pulmonary function tests.ConclusionThe present study concluded that the presence of BHR to methacholine identifies patients with mild to moderate COPD who are likely to respond to ICS treatment.