ABSTRACT
Tying to evaluate benefits and side effects of inhaled and oral steroids in patients with chronic obstructive pulmonary disease [COPD], this study was conducted on 70 patients with COPD. They were selected from patients in A-Hussein University Hospital from January 2002 to January 2003. Patients were divided into 5 groups:-Group [1]: included 20 patients receiving oral prednisolone 20 mg single morning dose, Group [2]: included 20 patients receiving inhaled steroids, [750 mirco g BDP/day], Group [3]: included 20 patients receiving inhaled steroids [1500 mirco BDP/day], Group [4]: included 5 patients receiving oral placebo and Group [5]: included 5 patients receiving inhaled placebo. Pulmonary function tests, morning serum cortisol level and bone mineral density [BMD] were measured. Results obtained showed: It was found that both oral and inhaled corticosteroids [Cs] caused significant improvement in pulmonary functions in a minority of patients [20% in oral Cs and 10% inhaled Cs]. The improvement with oral was higher than that with inhaled [Cs] and was achieved in the 1st month and continuing the treatment for 3 months kept the improvement but did not increase it significantly. The improvement with low dose inhaled and high dose inhaled CS was nearly similar. Oral CS decreased BMD while inhaled Cs showed no change in BMD during the treatment period. Also oral CS caused adrenal suppression in 70% of patients. Inhalation of high dose of CS caused adrenal suppression in 30% of patients, while low dose did not affect HPA axis. Thus the effect of inhaled CS on HPA axis was dose dependent