Abstract
There is controversy as to whether effects on mood play a role in mediating the response to corticosteroids in chronic obstructive pulmonary disease (COPD). If alterations in mood are important, it is conceivable that psychotropic drugs such as mianserin might produce similar responses to prednisolone in patients with COPD.
Twelve patients age 62.5 y, with FEV1 29% of predicted and <15% reversibility to salbutamol completed a randomised, double-blind crossover study. After an initial three week placebo run-in period patients received three weeks of prednisolone 40mg daily or mianserin 60–90 mg daily with an intervening three week placebo washout period. Full respiratory function tests, bicycle ergometry and 6 minute walks were performed before and after the run-in and at the end of each period. Psychological and functional assessments were also made at each visit.
Prednisolone significantly increased FVC, maximum ventilation (VEmax) and maximum heart rate (HRmax) compared with placebo, with mean for the difference of 0.251, 2.561 · min−1 and 12 beats · min−1 respectively. FVC, maximum oxygen uptake (VO2max) and HRmax were also significantly increased with prednisolone compared with mianserin. Anxiety scores were significantly lower with prednisolone compared with placebo. In contrast, mianserin had no significant effects on lung function, exercise or psychological parameters compared with placebo.
The improvements in ventilation, exercise and anxiety scores following treatment with prednisolone were not reproduced by mianserin, suggesting that the effects of prednisolone in COPD are unlikely to be due to alterations in mood.
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References
Wedzicha JA (1993) Inhaled corticosteroids in COPD: awaiting controlled trials. Thorax 48: 305–307
Rudd R (1984) Corticosteroids in chronic bronchitis. BMJ 288: 1553–1554
Weir DC, Burge PS (1993) Effects of high dose inhaled beclomethasone dipropionate 750 μg and 500 μg twice daily and 40 mg per day oral prednisolone on lung function, symptoms and bronchial hyperresponsiveness in patients with non asthmatic chronic airflow obstruction. Thorax 48: 309–316
Harding SM, Freedman S (1978) A comparison of oral and inhaled steroids in patients with chronic airways obstruction: features determining response. Thorax 33: 214–218
Weir DC, Gove RI, Robertson AS, Burge PS (1990) Corticosteroid trials in non-asthmatic chronic airflow obstruction: a comparison of oral prednisolone and inhaled beclomethasone dipropionate. Thorax 45: 112–117
Auffaith B, Postma DS, de Manchy JGR, Kander Mark Th W, Boorsma M, Koeter GH (1991) Effects of inhaled budesonide on spirometric values, reversibility, airway responsiveness and cough threshold in smokers with chronic obstructive lung disease. Thorax 46: 372–377
Mitchell DM, Gildeh P, Rehahn M, Dimond AM, Collins JV (1984) Effects of prednisolone in chronic airflow limitation. Lancet II: 193–195
Mendella LA, Manfreda J, Warren CPW, Anthonisen NR (1982) Steroid response in stable chronic obstructive pulmonary disease. Ann Intern Med (1982) 96: 17–21
Mitchell DM, Gildeh P, Rehahn M, Diamond AM, Collins JV (1984) Psychological changes and improvement in chronic airflow limitation after corticosteroid treatment. Thorax 39: 924–927
Ling MHM, Perry PJ, Ming TT (1981) Side effects of corticosteroid therapy. Psychiatric aspects. Arch Gen Psychiatry 38: 471–477
Morgan AD, Peck DF, Buchanon DR, McHardy GJR (1983) Effects of attitudes and beliefs on exercise tolerance in chronic bronchitis. BMJ 286: 171–173
Rutter BM (1977) Some psychological concomitants of chronic bronchitis. Psychol Medicine 7: 459–464
Oswald NC, Waller RE, Drinkwater J (1970) Relationship between breathlessness and anxiety in asthma and bronchitis. A comparative study. BMJ 2: 14–17
Marshall RJ (1983) The pharmacology of mianserin — an update. Br J Clin Pharmacol 15: 263S-268S
American Thoracic Society (1987) Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease (COPD) and asthma. Am Rev Resp Dis 137: 225–244
American Thoracic Society (1987) Standardisation of spirometry — 1987 Update. Am Rev Resp Dis 136: 1285–1298
Borg G (1970) Perceived exertion as an indicator of somatic stress. Scand J Rehab Med 2–3: 92–98
Eysenck HJ, Eysenck SBG (1964) Manual of the Eysenck personality inventory. Hodder & Stoughton, Kent
Crown S, Crisp AH (1966) A short clinical diagnostic self-rating scale for psychoneurotic patients. Br J Psychiatry 112: 917–923
Cooper P, Osborn M, Gath D, Feggetter G (1982) Evaluation of a modified self-report measure of social adjustment. Br J Psychiatry 141: 68–75
Lipworth BJ, Clark RA, Dhillon DP, Moreland TA, Struthers AD, Clark GA, McDevitt DG (1989) Pharmacokinetics, efficacy and adverse effects of sublingual salbutamol in patients with asthma. Eur J Clin Pharmacol 37: 567–571
Brown RA, Swanson Beck J (1990) Comparison of several groups: the analysis of variance. In: Brown RA, Swanson Beck J (eds) Medical statistics on Microcomputers. BMJ Publications, London pp 34–42
Mungall IPF, Hainsworth R (1979) Assessment of respiratory function in patients with chronic obstructive airways disease. Thorax 34: 254–258
Newnham DM, Dhillon DP, Winter JM, Jackson CM, Clark RA, Lipworth BJ (1993) Bronchodilator reversibility to low and high doses of terbutaline and ipratropium bromide in patients with chronic obstructive pulmonary disease. Thorax 48: 1151–1155
Bellamy D, Hutchison DCS (1981) The effects of salbutamol aerosol on lung function in patients with pulmonary emphysema. Br J Dis Chest 75: 190–196
Connellan SJ, Gough SE (1982) The effects of nebulised salbutamol on lung function and exercise tolerance in patients with severe airflow obstruction. Br J Dis Chest 76: 135–142
Tweedale PH, Alexander F, McHardy GJR (1987) Short term variability in FEV1 and bronchodilator responsiveness in patients with obstructive ventilatory defects. Thorax 42: 487–490
Chrystyn H, Mulley BA, Peake MD (1988) Dose response relation to oral theophylline in severe chronic obstructive airways disease Br Med J 297: 1506–1510
Spiro SG, Hahn HL, Edwards RHT, Pride NB (1974) Cardiorespiratory adaptations at the start of exercise in normal subjects and in patients with chronic obstructive bronchitis. Clin Sci Mol Med 47: 165–172
Belman MJ (1993) Exercise in patients with chronic obstructive pulmonary disease. In: Muir JF, Pierson DJ (eds) Pulmonary rehabilitation in chronic respiratory insufficiency. Thorax 48: 936–946
Coppen A, Gupta R, Montgomery S, Ghose K, Bailey J, Burns B, de Ridder JJ (1976) Mianserin Hydrochloride: a novel antidepressant. Br J Psychiatry 129: 342–345
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Grove, A., Lipworth, B.J., Ingram, C.G. et al. A comparison of the effects of prednisolone and mianserin on ventilatory, exercise and psychometric parameters in patients with chronic obstructive pulmonary disease. Eur J Clin Pharmacol 48, 13–18 (1995). https://doi.org/10.1007/BF00202165
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DOI: https://doi.org/10.1007/BF00202165