Multicentre randomised placebo-controlled trial of inhaled fluticasone propionate in patients with chronic obstructive pulmonary disease. International COPD Study Group.

BACKGROUND: The efficacy of inhaled corticosteroids in the treatment of chronic obstructive pulmonary disease (COPD) remains controversial because of a lack of placebo-controlled studies. We compared the effect of inhaled fluticasone propionate with placebo in the treatment of patients with COPD. METHODS: We used a randomised, double-blind, placebo-controlled design. We enrolled from 13 European countries, New Zealand, and South Africa, 281 outpatient current or ex-smokers, aged between 50 and 75 years. They had a forced expiratory volume in 1 s (FEV1) of between 35% and 90% of predicted normal values, a ratio of FEV1 to forced vital capacity of 70% or less and bronchodilator reversibility of less than 15%, as well as a history of chronic bronchitis. Patients were randomly assigned fluticasone propionate 500 microg (n=142) or placebo (n=139) twice daily via a metered-dose inhaler for 6 months. The main outcome measures were the number of patients who had at least one exacerbation by the end of treatment, the number and severity of exacerbations, clinic lung function, diary card symptoms and peak expiratory flow and 6 min walking distance. FINDINGS: 51 (37%) patients in the placebo group compared with 45 (32%) in the fluticasone propionate group had had at least one exacerbation by the end of treatment (p=0.449). Significantly more patients had moderate or severe exacerbations in the placebo group than in the fluticasone propionate group (86% vs 60%, p<0.001). Diary-card and clinic morning peak expiratory flows improved significantly in the fluticasone propionate group (p<0.001, p=0.048, respectively), as did clinic FEV1 (p<0.001), forced vital capacity (p<0.001), and mid-expiratory flow (p=0.01). Symptom scores for median daily cough and sputum volume were significantly lower with fluticasone propionate treatment than with placebo (p=0.004 and p=0.016, respectively). At the end of treatment, patients on fluticasone propionate had increased their 6 min walking distance significantly more than those on placebo (p=0.032). Fluticasone propionate was tolerated as well as placebo, with few adverse effects and without a clinically important effect on mean serum cortisol concentration. INTERPRETATION: Fluticasone propionate may be of clinical benefit in patients with COPD over at least 6 months. Inhaled corticosteroids may have an important role in the long-term treatment of COPD.

[Intruders or innovators. More women physicians?]. / Inntrengere eller nyskapere. Flere kvinnelige leger?

The article discusses the impact of an increasing proportion of women medical doctors in Norway. Will a changing gender composition affect the medical culture as such and, in the event, how? The theoretical point of departure is the social construction of gender. One argument is that gender relations tend to be reconstructed through gendered processes, many of them leading to new forms of gendered divisions of labour among doctors. Women doctors may be considered as the same as, or as different from their male colleagues. Such a distinction is often blurred, but is nevertheless operative. Medicine as a system of production of scientific knowledge is itself assumed to be primarily a product of male thoughts and ideas. Conventional forms and procedures may be challenged by its new members. Medical work as such runs the risk of being trivialized. To both understand and explain current developmental tendencies and contradictions, we need to identify gendered dynamics. There are no easy political solutions, however, to the "gender question" in medicine.

Effects of withdrawal of sustained-release theophylline in patients with chronic obstructive lung disease.

In a double-blind, cross-over study, sustained-release theophylline was withdrawn to determine whether the drug was still effective after long-term treatment. Twenty adult out-patients with stable, chronic obstructive lung disease and who had been on continuous long-term treatment for at least 6 months, were studied. Lung function, plasma theophylline concentration, symptom score, number of nocturnal dyspnoea attacks, requirement for additional beta 2-stimulant aerosol, and side effects, were recorded before withdrawal, after withdrawal and after reinstitution of treatment. When theophylline was withdrawn, all parameters were significantly worsened, but after reinstitution of treatment they all improved significantly. The results show that sustained-release theophylline remains effective after at least 6 months' continuous treatment in adult patients.