The effect of inhaled glucocorticosteroids in emphysema due to α1-antitrypsin deficiency

Abstract Despite the success of inhaled steroids in controlling asthma, the benefit in patients with chronic obstructive pulmonary disease (COPD) remains controversial. Five subjects with moderate to severe emphysema due to α 1 -antitrypsin deficiency (phenotype PiZ) were followed with daily home spirometry in a 2 × 8 weeks, randomized double-blind, placebo-controlled, crossover study of inhaled budesonide 0·8 mg b.i.d. In three of the five patients, there was a statistically significant increase in the mean forced expiratory volume in 1 s (FEV 1 ), and in two of these patients, there was also a statistically significant increase in the mean forced vital capacity (FVC) during budesonide treatment. A significant diurnal variation in FEV 1 and FVC was found in three and two patients, respectively, but did not change significantly during treatment. These findings emphasize the need for renewed evaluation of inhaled steroids in the treatment of patients with emphysema, and indicate that individual patients may have significant clinical improvement.