呼吸疾病研究所呼气相气道内负压法检测呼气流速受限在支气管哮喘患者中的应用

目的 探讨支气管哮喘(简称哮喘)患者呼气流速受限(EFL)与呼吸困难严重程度的相关性,观察吸入支气管扩张剂对哮喘患者EFL的影响.方法 采用呼气相气道内负压法(NEP)检测65例哮喘患者支气管扩张试验前、后(吸入沙丁胺醇400 μg)EFL情况.结果 65例哮喘患者中有26例(40%)出现EFL,其中11 例仅仰卧位时出现,15例仰卧位及坐位均出现.EFL和无EFL者(N-EFL)第一秒用力呼气容积占预计值百分比(FEV1占预计值%)分别为(52±15)%、( 77±18)%,两组比较差异有统计学意义(t＝5.822,P＜0.01).仅仰卧位有EFL(S-EFL)者和仰卧位、坐位均有EFL(SS-EFL)者FEV1占预计值%分别为(64±10)%、(43±12)%,两组比较差异有统计学意义(t值分别为2.283、6.694,P分别＜0.01、＜0.05).3分法和5分法EFL均与FEV1占预计值%呈负相关(r值分别为-0.637、-0.630,P均＜0.01).第一秒用力呼气容积(FEV1)与加拿大医学研究委员会推荐的呼吸困难严重程度分级标准(MRC评分)呈负相关(r=-0.501,P＜0.01),3分法和5分法EFL均与MRC评分呈正相关(r值分别为0.627、0.636,P均＜0.01).17例FEV1占预计值%＜70%并存在EFL的患者吸入沙丁胺醇后,9例EFL完全消失,5例从SS-EFL变为S-EFL,吸入沙丁胺醇后3分法和5分法EFL评分均较吸入前差异有统计学意义(t值分别为6.769、6.010,P均＜0.01).结论 与FEV1比较,EFL与哮喘患者呼吸困难严重程度相关性更强,可作为评价患者呼吸困难严重程度更可靠的客观指标.哮喘患者EFL可被吸入支气管扩张剂逆转,即表现为可逆性EFL.     

不同指标对老年严重慢性阻塞性肺疾病患者吸入支气管舒张剂疗效的评价

目的 对评价严重慢性阻塞性肺疾病(COPD)患者吸入支气管舒张剂疗效的3种指标进行比较. 方法 吸人复方异丙托溴胺溶液前后对18例稳定期严重COPD患者行肺通气功能和肺容量测定,并采用呼气负压技术同步检测呼气流速受限(EFL). 结果 与安慰剂比较,吸入支气管舒张剂后COPD患者第1秒用力呼气容积占预计值(FEV1)百分比、用力肺活量占预计值(FVC)百分比、深吸气量占预计值(IC)百分比显著改善,残气量占预计值(RV)百分比和功能残气量占预计值(FRC)百分比显著降低,肺总量占预计值(TLC)百分比无显著改变;Borg呼吸困难评分显著降低;5分法EFL评分无显著改变,呼吸方式无显著改变.IC、FEV,和5分法EFL评分的平均改善率分别是(20.42±15.02)%、(10.98±7.28)%和(5.15±11.24).△IC与ABorg呈负相关(r=0.732,P<0.05),AFEVl与ABorg相关关系无统计学意义(r=0.343,P>0.05).应用受试者工作特征曲线方法分析3种不同指标诊断呼吸困难的价值,结果表明,IC、FEV1和5分法EFL评分的曲线下面积分别为0.868、0.681和0.557. 结论 与FEV1相比,IC评价严莺COPD患者支气管舒张剂疗效更为灵敏和准确,5分法EFL评分不宜作为评价严重COPD患者吸人支气管舒张剂疗效的指标.     

吸入沙丁胺醇对慢性阻塞性肺疾病患者呼气流速受限的影响

目的　评价吸入支气管扩张剂治疗对慢性阻塞性肺疾病 (COPD)患者呼气流速受限 (EFL)的影响。方法　 2 8例稳定期中、重度COPD患者在吸入沙丁胺醇干粉剂前后行常规肺功能测定和呼气负压 (NEP)测试。结果　NEP测试显示所有患者均存在EFL。吸入沙丁胺醇后FEV1 ,FVC和FEF50 iso vol均有显著增高 ,流速受限 (FL)指数则明显下降〔(79.1± 1 2 .0 ) %与 (63 .2± 1 2 .9) % ,P <0 .0 1〕。 1 1例COPD患者的FEV1 ≥ 1 5 % (阳性组 ) ,其余1 7例FEV1 <1 5 % (阴性组 ) ,两组患者的FEF50 iso vol和FL指数则无明显差异 (FEF50 iso vol为 (43 .3± 2 0 .2 ) %与 (39.6± 2 1 .7) % ,FL指数为〔(2 1 .5± 8.4) %与 (1 9.6± 1 1 .7) % ,均P >0 .0 5〕。FL指数与ΔFEF50 % iso vol呈显著相关(r =0 .50 8,P <0 .0 1 ) ,而与FEV1 的相关性不明显 (r=0 .1 0 6 ,P >0 .0 5)。结论　COPD患者在吸入支气管扩张剂后其EFL可得到显著改善 ,FVC和FEV1 均显著增加 ,EFL的改善程度相当于FEF50 %的改变程度     

对比呼气负压与传统方法检测慢性阻塞性肺疾病患者呼气气流受限

目的 对比呼气负压(NEP)与传统方法 检测慢性阻塞性肺疾病(COPD)患者呼气气流受限(EFL).方法 应用NEP与传统方法 (层流型流最计)检测72例COPD缓解期患者EFL;对20例不能完成传统测试的患者应用NEP检测其EFL;对比两种方法 的检测结果 .结果 72例COPD患者应用NEP 54例(75%)检测到EFL.第1秒用力呼气容积(FEV_1)占预计值百分比EFL评分2分者为(46.92±12.74)%,3分者为(33.35±8.96)%,显著低于EFL评分1分者[(63.60±16.65)%].ROC曲线分析NEP曲线下面积(AUC)为0.903,层流型流量计AUC为0.761.20例不能完成传统测试的患者均能耐受NEP测试,19例检测到EFL.结论 应用NEP检测COPD患者EFL,比应用传统方法 检测更能准确反映COPD患者呼吸困难的严重程度;NEP操作简单、无需患者主动配合,可在不能完成传统测试的患者中应用.     

抑制COPD患者乙酰甲胆碱诱发的支气管收缩

作者观察吸入支气管扩张剂对COPD 患者诱发支气管收缩的效果。实验分二组:一组为COPD 患者,共10例,平均年龄58岁,男6例,女4例,10例均有吸烟史,9例有呼吸困难,3例慢性咳嗽达2年以上,所有患者肺功能基础值为:FEV_1为预计值的62±21%,FEV_1/FVC     

呼气流速受限在支气管舒张试验中的可行性

1994年Valta等首次提出了不需患者主动配合用力呼吸而仅在潮气呼吸下进行的呼气相气道内负压（NEP法）检测呼气流速受限（EFL）的方法，目前采用NEP法检测慢性阻塞性肺疾病（COPD）和支气管哮喘（简称哮喘）患者EFL的相关研究结果提示，EFL比第一秒用力呼气容积（FEV1）能更敏感反映COPD和哮喘患者呼吸困难和病情的严重程度。但目前有关NEP法检测EFL在支气管舒张试验中的可行性尚不明确。我们采用NEP法检测COPD和哮喘患者吸入支气管舒张剂沙丁胺醇前、后EFL的变化，并与常规FEV1判断指标进行比较，探讨NEP法检测EFL在支气管舒张试验中的可行性。     

吸入支气管舒张剂对慢性阻塞性肺疾病患者动态内源性呼气末正压的影响

目的评价吸入支气管舒张剂对中重度慢性阻塞性肺疾病(COPD)患者平静呼吸状态动态内源性呼气末正压(PEEPi,dyn)的影响。方法2005年5月,对广州医学院第一附属医院广州呼吸疾病研究所20例中重度COPD患者分别在基础状态与吸入安慰剂30min,测定基础肺功能、主观呼吸困难评分(Borgscore)和PEEPi,dyn后,病例分成3组:Ⅰ组吸入沙丁胺醇400μg15min后;Ⅱ组顺序吸入异丙托溴胺80μg30min和吸入沙丁胺醇400μg15min后;Ⅲ组顺序吸入沙丁胺醇400μg15min和吸入异丙托溴胺80μg30min后分别重复上述指标测定。结果与吸入安慰剂对比,吸入支气管舒张剂后,3组PEEPi,dyn均明显降低(P<0.05～0.01),PEEPi,dyn的变化与深吸气量(IC)的变化呈显著负相关(r=-0.444,P<0.01),与第一秒钟用力呼气容积的改变呈显著负相关(r=-0.517,P<0.01);3组Borgscore均降低(P<0.05),Borgscore的降低与PEEPi的降低明显呈正相关(r=0.386,P<0.05),与肺功能的变化无显著相关。结论(1)吸入支气管舒张剂后,COPD患者的PEEPi,dyn降低,其机制与肺容量的降低有关。(2)吸入支气管舒张剂后,COPD患者呼吸困难的减轻与PEEPi,dyn的降低有关。     

呼气相负压检测呼气流速受限对阻塞性睡眠呼吸暂停低通气综合征的评价

目的　探讨呼气相气道内负压（NEP）检测阻塞性睡眠呼吸暂停/低通气综合征（OSAHS）患者呼气流速受限（EFL）作为评估上气道塌陷性指标的可行性及其与OSAHS严重度的相关性。方法　采用NEP法（-5cmH2O）检测OSAHS患者及健康对照者仰卧位和坐位EFL情况。OSAHS组33例,均为男性,平均年龄（47±12）岁;健康对照组20例,男15例,女5例,平均年龄（42±10）岁。结果　20例健康对照组均无EFL。33例OSAHS患者中10例（30.3%）检测出EFL,其中15例轻中度OSAHS组仅1例（6.7%）出现EFL,而18例重度OSAHS组9例（50%）出现EFL,两组间EFL发生率差异有统计学意义（P〈0.01）。EFL组呼吸暂停低通气指数（AHI）、呼吸暂停总次数（TNA）和低氧指数（DI）均显著高于无EFL组（分别为65.66±22.20和36.50±21.74、372.60±214.46和173.39±133.65、65.18±23.22和38.59±22.02,P均〈0.01）,而夜间最低氧饱和度（NNSp）显著低于无EFL组（58.80±12.78和71.00±9.30,P〈0.01）。3分法和5分法EFL均与AHI、DI、TNA呈显著正相关（3分法EFL的相关系数分别为0.548、0.513、0.472,5分法EFL的相关系数分别为0.560、0.524、0.469,P均〈0.01）,与NNSp呈显著负相关（相关系数分别为-0.514和-0.508,P均〈0.01）。多元回归分析结果显示,5分法EFL对AHI和DI均有显著预测意义（标准化偏回归系数分别为0.495和0.402,P均〈0.01）。结论　采用NEP法在清醒状态下检测EFL可在一定程度上反映OSAHS患者上气道塌陷性增加及OSAHS病情严重程度,可望成为OSAHS初筛诊断和动态观察评估病情严重程度及疗效的简便、可靠的方法。     

呼气负压技术在慢性阻塞性肺疾病患者中的应用

目的 探讨呼气负压技术在不能完成常规肺功能测定的慢性阻塞性肺疾病（COPD）患者中的临床应用价值。方法 采用呼气负压技术检测13例不能完成常规肺功能检查的COPD患者呼气流速受限。结果13例均能耐受呼气负压技术检测，无不良反应发生，12例有呼气流速受限，呼气流速受限评分5分法与MRC（medical research council）呼吸困难评分呈显著正相关，5分法呼气流速受限评分对呼吸困难有显著预测意义。结论 呼气负压技术是一种操作简单、非侵袭性、不需患者主动配合的肺功能检查方法，可在不能完成常规肺功能检查的患者中应用。     

用力吸气流量在COPD和支气管哮喘中的应用

目的 评价用力吸气流量指标在慢性阻塞性肺疾病(COPD)和支气管哮喘中价值。方法 观察COPD80例和支气管哮喘20例在吸入支气管扩张剂后用力吸气流量指标的前后变化。结果 轻度COPD患者和支气管哮喘患者FEV1,FIV1，PEF，PIF，FEF50％，FIF50%指标，在吸入支气管扩张剂前后均有明显的差异。但用力吸气流量指标与用力呼气流量指标在统计学无差别。而中、重度COPD患者FIV1％较FEV1％有显著差异性。结论 在COPD中，在评价支气管的可逆性方面，用力吸气流量具有用力呼气流量同样的效果。甚至在重度COPD患者中．FIV1%比用力呼气流量可能更加敏感。     

Reproducibility of the negative expiratory pressure technique in COPD

BACKGROUND: Tidal expiratory flow limitation (EFL) contributes to chronic dyspnea and exercise intolerance in COPD patients. It can be assessed with the negative expiratory pressure (NEP) technique and is expressed as either the percentage of the tidal volume over which EFL occurs (EFL%Vt) or according to more detailed three-point or five-point scoring systems. The aim of this study was to evaluate the reproducibility of the NEP technique in COPD patients. METHODS: Tidal EFL was evaluated with NEP in 18 subjects with stable COPD (FEV(1) range, 18 to 75% predicted) on two occasions (mean retest interval, 8.2 days) by the same rater. Agreement between testing occasions was assessed with the kappa statistic for the 3-point and 5-point EFL scores, and with the coefficient of repeatability for EFL%Vt. RESULTS: On the first testing occasion, nine subjects had no EFL, four subjects had EFL in the supine position, and five subjects had EFL in the sitting and the supine position. Using the 3-point score, agreement was present in 14 of 18 subjects at time 2 (kappa = 0.66), indicating substantial agreement. Using the 5-point score, agreement was seen in 13 of 18 subjects (kappa = 0.61), also indicating substantial agreement. The reproducibility of EFL%Vt measurements was lower than that required to reliably detect clinical change in both the sitting and supine positions (coefficient of repeatability, 37% and 58%, respectively). CONCLUSIONS: The 3-point and 5-point scores provide a reproducible assessment of EFL in COPD patients. The classification of EFL as a percentage of tidal volume is less reproducible, and large changes are required to be confident that real clinical change has occurred.     

Tidal expiratory flow limitation, dyspnoea and exercise capacity in patients with bilateral bronchiectasis.

In this study the authors investigated whether expiratory flow limitation (FL) is present during tidal breathing in patients with bilateral bronchiectasis (BB) and whether it is related to the severity of chronic dyspnoea (Medical Research Council (MRC) dyspnoea scale), exercise capacity (maximal mechanical power output (WRmax)) and severity of the disease, as assessed by high-resolution computed tomography (HRCT) scoring. Lung function, MRC dyspnoea, HRCT score, WRmax and FL were assessed in 23 stable caucasian patients (six males) aged 56 +/- 17 yrs. FL was assessed at rest both in seated and supine positions. To detect FL, the negative expiratory pressure (NEP) technique was used. The degree of FL was rated using a five-point FL score. WRmax was measured using a cyclo-ergometer. According to the NEP technique, five patients were FL during resting breathing when supine but not seated, four were FL both seated and supine, and 14 were NFL both seated and supine. Furthermore, it was shown that: 1) in stable BB patients FL during resting breathing is common, especially in the supine position; 2) the degree of MRC dyspnoea is closely related to the five-point FL score; 3) WRmax (% pred) is more closely correlated with the MRC dyspnoea score than with the five-point FL score; and 4) HRCT score is closely related to forced expiratory volume in one second % pred but not five-point FL score. In conclusion, flow limitation is common at rest in sitting and supine positions in patients with bilateral bronchiectasis. Flow limitation and reduced exercise capacity are both associated with more severe dyspnoea. Finally, high-resolution computed tomography scoring correlates best with forced expiratory volume in one second.     

Tidal expiratory flow limitation and chronic dyspnoea in patients with cystic fibrosis.

Cystic fibrosis (CF) eventually leads to hyperinflation linked to tidal expiratory flow limitation (FL) and ventilatory failure. Presence of FL was assessed at rest in 22 seated children and adults with CF (forced expiratory volume in one second (FEV1) range: 16-92% predicted), using both the negative expiratory pressure (NEP) technique and the "conventional" method based on comparison of tidal and maximal expiratory flow/volume curves. In addition, chronic dyspnoea was scored with the modified Medical Research Council (MRC) scale. Measurements were made before and 15 min after inhalation of salbutamol. With NEP, FL was present in only three malnourished patients, who had the lowest FEV1 values (16-27% pred) and claimed very severe dyspnoea (MRC score 5). By contrast, an additional seven patients were classified as FL with the conventional method. Six of these patients had little or no dyspnoea (MRC scores 0-1). Salbutamol administration had no effect on the extent of FL, and the concomitant decrease in functional residual capacity (FRC) was too small to play any clinically significant role. This study concluded that in seated patients with cystic fibrosis, expiratory flow limitation is absent at rest, unless the forced expiratory volume in one second is <30% predicted. If present, expiratory flow limitation is associated with severe chronic dyspnoea. The conventional method for assessing expiratory flow limitation is not reliable and bronchodilator administration has little effect on expiratory flow limitation.     

老年慢性阻塞性肺疾病合并陈旧性肺结核患者抑郁相关因素调查研究

目的 探讨老年慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)合并陈旧性肺结核患者抑郁相关影响因素.方法 对比分析老年COPD合并陈旧性肺结核120例、单纯COPD110例患者的一般资料,肺功能,血气分析结果,COPD Assessment Test (CAT)、...     

慢性阻塞性肺疾病合并肺纤维化的肺动脉压力变化及其与肺功能和生活质量关系的研究

目的探究慢性阻塞性肺疾病(COPD)合并肺纤维化患者的肺动脉压力变化及其与肺功能、生活质量的关系。方法 回顾性对比分析天津医科大学总医院2009年7月至2011年3月诊断的20例COPD合并肺纤维化及随机抽取同期30例单纯COPD患者的肺动脉收缩压、肺功能、Medieal Research Council dyspne...     

Use of a mucus clearance device enhances the bronchodilator response in patients with stable COPD

STUDY OBJECTIVE: To determine whether the use of a mucus clearance device (MCD) [Flutter; Axcan Scandipharm; Birmingham, AL] could improve the bronchodilator response to inhaled ipratropium and salbutamol delivered by a metered-dose inhaler in patients with stable, severe COPD. PATIENTS: Twenty-three patients with severe COPD were studied. Mean +/- SD age was 71.7 +/- 6.3 years. Mean FEV(1) was 0.74 +/- 0.28 L or 34.5 +/- 12.7% predicted. METHODS: Patients were tested in random order on 2 subsequent days after using an MCD or a sham MCD. A bronchodilator (four puffs; each puff delivering 20 microg of ipratropium bromide and 120 microg of salbutamol sulfate) was administered by metered-dose inhaler with a holding chamber after use of the MCD or sham MCD. Spirometry was performed before and after use of the MCD or sham MCD, and at 30 min, 60 min, and 120 min after the bronchodilator. Six-minute walk distance was tested between 30 min and 60 min; oxygen saturation, pulse, and a dyspnea score were recorded before and after walking. RESULTS: Immediately after use of the MCD, but not the sham MCD, there was a statistically significant (p < 0.05) improvement in FEV(1) and FVC (11 +/- 24% vs 1 +/- 7% and 18 +/- 33% vs 6 +/- 18%, respectively). Whether patients were pretreated with the MCD or sham MCD, there was a significant improvement in FEV(1) and FVC compared to baseline with combined bronchodilator therapy. At 120 min, the change in FEV(1) after treatment with the MCD was greater than with the sham MCD (186 +/- 110 mL vs 130 +/- 120 mL; p < 0.05). When comparing the MCD to the sham MCD, 6-min walk distance was greater (174 +/- 92 m vs 162 +/- 86 m; p < 0.05), with less dyspnea before and at the end of walking. CONCLUSION: Patients with severe COPD may demonstrate a significant bronchodilator response to combined ipratropium and salbutamol delivered by metered-dose inhaler. This response may be enhanced and additional functional improvement obtained with the prior use of a bronchial MCD.     

Expiratory flow limitation is associated with orthopnea and reversed by vasodilators and diuretics in left heart failure

BACKGROUND: In patients with acute left heart failure (LHF), orthopnea has also been related to the occurrence or worsening of expiratory flow limitation (EFL) in the supine position. We wished to assess whether short-term treatment with vasodilators and diuretics was able to abolish supine EFL and whether this could help to control orthopnea in patients with acute LHF. METHODS: In nine nonobese (ie, mean [+/- SD] body mass index, 24 +/- 5 kg/m2), never-smoker patients (two men and seven women; mean age, 77 +/- 7 years) with acute LHF (mean ejection fraction, 43 +/- 15%), we assessed EFL by the negative expiratory pressure method and dyspnea by the Borg scale, with patients in both the seated and supine positions, before and after short-term treatment with vasodilators and diuretics until hospital discharge. Orthopnea was defined as a positive difference in the Borg score between measurements made with the patient in the supine and seated positions. Postural variations in the end-expiratory lung volume were inferred from changes in inspiratory capacity (IC) that were measured under the same circumstances. RESULTS: Before treatment, with the patient in the seated position the mean dyspnea score was 1.5 +/- 0.5, the mean IC was 1.49 +/- 0.38 L, seven patients were non-flow-limited, and two patients were flow-limited. During recumbency, the mean dyspnea score was 2.7 +/- 0.5 (p < 0.01 vs seated position values), the mean IC was 1.66 +/- 0.45 L, and seven patients exhibited EFL. After a mean duration of 17 +/- 8 days of treatment (range, 7 to 28 days), EFL was detected in two patients only in the supine position, IC increased both in the seated position (1.65 +/- 0.34 L; p < 0.01) and the supine position (1.81 +/- 0.41 L; p = 0.07) position, and, although only two patients denied orthopnea, the mean dyspnea score during recumbency actually decreased to 1.9 +/- 1.0 (p < 0.05). CONCLUSIONS: Our results indicate that short-term treatment with vasodilators and diuretics is able to control orthopnea and to remove supine EFL in most patients with acute LHF, suggesting a posture-related increase in bronchial obstruction as the main mechanism of EFL, which appears to play a role in the occurrence and severity of orthopnea in these circumstances.     

Expiratory flow limitation and orthopnea in massively obese subjects

BACKGROUND: Morbidly obese subjects, who often complain about breathlessness when lying down, breathe at low lung volume with a reduced expiratory reserve volume (ERV). Therefore, during tidal breathing the expiratory flow reserve is decreased, promoting expiratory flow limitation (EFL), which is more likely to occur in the supine position, when the relaxation volume of the respiratory system, and hence the functional residual capacity (FRC), decrease because of the gravitational effect of the abdominal contents. PURPOSE: The aim of the study was to assess EFL and orthopnea in massively obese subjects and to evaluate whether orthopnea was associated with the development of supine EFL. METHODS: In 46 healthy obese subjects (18 men) with a mean (+/- SD) age of 44 +/- 11 years and a mean body mass index (BMI) of 51 +/- 9 kg/m(2), we assessed EFL in both the seated and the supine positions by the negative expiratory pressure method and assessed postural changes in FRC by measuring the variations in the inspiratory capacity (IC) with recumbency. Simultaneously, dyspnea was evaluated in either position using the Borg scale dyspnea index (BSDI) to determine the presence of orthopnea, which was defined as any increase of the BSDI in the supine position. RESULTS: Partial EFL was detected in 22% and 59%, respectively, of the overall population in seated and supine position. The mean increase in the supine IC amounted to 120 +/- 200 mL (4.1 +/- 6.4%), indicating a limited decrease in FRC with recumbency in these subjects. Orthopnea, although mild (mean BSDI, 1.7 +/- 1.3), was claimed by 20 subjects, and in 15 of them EFL occurred or worsened in the supine position. Orthopnea was associated with lower values of seated ERV (p < 0.05) and was marginally related to supine EFL values (p = 0.07). No significant effect of age, BMI, obstructive sleep apnea-hypopnea syndrome, FEV(1), and forced expiratory flow at 75% of vital capacity was found on either orthopnea or EFL. CONCLUSION: In morbidly obese subjects, EFL and dyspnea frequently occur with the subject in the supine position, and both supine EFL and low-seated ERV values are related to orthopnea, suggesting that dynamic pulmonary hyperinflation and intrinsic positive end-expiratory pressure may be partly responsible for orthopnea in massively obese subjects.     

Response to oral corticosteroid in patients with chronic obstructive pulmonary disease.

We studied the effect of 30 mg of prednisolone on 29 Japanese patients with chronic obstructive pulmonary disease (COPD). The mean value of the baseline forced expiratory volume in one second (FEV1; mean +/- SEM) was 1.14 +/- 0.12 l (46.9 +/- 3.9% pred) and the FEV1 following the steroid trial was 1.30 +/- 0.12 l (53.7 +/- 4.3% pred). Post-trial FEV1--baseline FEV1/predicted FEV1 was 6.8 +/- 1.9%. Five patients (17%) had more than a 15% increase in FEV1 as a percentage of predicted FEV1. Post-trial FEV1/baseline FEV1 was 117.3 +/- 4.3%, and 12 patients (41%) had more than a 20% increase in FEV1 after the trial. Acute bronchodilator response to beta-agonist correlated positively with the response to corticosteroid. Baseline spirometries, blood eosinophil counts, serum IgE levels, sputum eosinophil counts, family history of asthma, and history of paroxysmal dyspnea did not vary across responders and non-responders. Patients with severe COPD should be treated to achieve the best possible pulmonary functions indicated by a steroid trial within the limit of acceptable levels of adverse effects.