Abrupt withdrawal of inhaled corticosteroids does not result in spirometric deterioration in chronic obstructive pulmonary disease: effect of phenotyping?

Some studies show a decline of FEV [1] only one month after withdrawal of inhaled corticosteroids [ICS], while others show no decline. We speculate that the presence of an asthma phenotype in the Chronic Obstructive Pulmonary Disease [COPD] population, and that its exclusion may result in no spirometric deterioration. We performed a prospective clinical observation study on 32 patients who fulfilled the Global Initiative for Chronic Obstructive lung disease definition of COPD [Grade II-IV]. They were divided into two phenotypic groups. 1. Irreversible asthma [A and B] [n = 13]: A. Asthma: Bronchial biopsy shows diffuse thickening of basement membrane [>/= 6.6 microm]. B. Airflow limitation [AFL] likely to be asthma: KCO > 80% predicted if the patient refused biopsy. 2. COPD [A and B] [n = 19]: A. COPD: hypercapneic respiratory failure with raised bicarbonate, panlobular emphysema with multiple bullas, or bronchial biopsy showing squamous metaplasia and epithelial/subepithelial inflammation without thickening of the basement membrane. B. AFL likely to be COPD: KCO < 80% predicted. The asthma phenotype was significantly younger, had a strong association with hypertrophy of nasal turbinates, and registered a significant improvement of FEV [1] [350 ml] vs a decline of - 26.5 ml in the COPD phenotype following therapy with budesonide/formoterol for one year. Withdrawal of budesonide for 4 weeks in the COPD phenotype resulted in FEV [1] + 1.33% [SD +/- 5.71] and FVC + 1.24% [SD +/- 5.32]; a change of <12% in all patients. We recorded no spirometric deterioration after exclusion of the asthma phenotype from a COPD group

Review of tuberculosis in Saudi Arabia

The prevalence of tuberculin reactivity in Saudi Arabia in children aged 5-14 years is 6% [which puts it in the rank of middle prevalence countries]. However, two spots of high prevalence exist: the City of Jeddah, and the urban centres in the Southern Region with statistically significant differences between Saudis and non-Saudis; these could have resulted from the pattern of settlers in Jeddah, and close social contact between the southern region and the Republic of Yemen The incidence of smear-positive pulmonary cases in Riyadh in 1991-92 was 15.2 per 100 000 and 1 predicted the nationwide incidence of all cases to be 30 per 100.000 which is about double the official notifications. The figures are 2-4 times higher than industrialized countries. There are alarming data of considerably high microbial resistance to antituberculosis drugs particularly in the Western and Southern Regions [where the majority of isolates are multi-drug resistant]. The microbial resistance and the high infection rates brought by legal and illegal settlers from poor countries are considered to be the greatest threat to future control of tuberculosis in Saudi Arabia. The review makes several recommendations