The addition of an inhaled corticosteroid--but not an inhaled anticholinergic agent--to maintenance treatment with a beta 2-agonist (terbutaline) substantially reduced morbidity, hyperresponsiveness, and airways obstruction in patients with a spectrum of obstructive airways disease.

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In a double-blind study of 2 parallel groups of 15 allergic asthmatic patients each, we investigated whether treatment with inhaled budesonide has a dose- and time-dependent effect on the degree of bronchial hyperreactivity. The patients were randomly allocated to treatment with either 200 or 800 micrograms budesonide per day for a period of 8 wk. The active treatment period was preceded by a selection period of 3 wk, and a single-blind placebo period of 2 wk. During these initial 5 wk the maintenance treatment of the patients, including cromolyn sodium and inhaled corticosteroids, was withheld. Spirometry and inhalation provocation tests with methacholine were carried out, and the symptom score was recorded every 2 wk. The methacholine provocation concentrations (geometric mean) causing a decrease in FEV1 of 20% (PC20) in the 200 and 800 micrograms/day treatment groups just before the active treatment period were 0.90 and 0.91 mg/ml, respectively. These values increased significantly to 1.21 and 1.84 mg/ml after 2 wk of treatment (p less than 0.05 and p less than 0.001, respectively) and to 1.55 and 2.74 mg/ml after 8 wk of treatment (p less than 0.01 and p less than 0.001). During the whole study period budesonide in a dosage of 800 micrograms/day induced a significantly larger change in PC20 than in a dosage of 200 micrograms/day. The FEV1 before treatment was 91 +/- 3% (SEM) and 84 +/- 2% of the predicted value in the 200 and 800 micrograms/day treatment groups, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

This study was undertaken to conlirni the high incidence of the 'late" bronchial reaclion after house dust inhalation and to assess whether symptoms and signs of these 'late' reactions were comparable with the clinical features of the classic Type HI (Ge!l and Coombs) allergic reactions in the lung as shown by extrinsic allergic alveolitis.Although the time sequence of this late reaction is in agreernent with the classic Type Ml reaction (Arthus phenomenon), other features of aiveolitis are absent. There were no crepitations on physical examination, no fever, no leucocytes, no decrease of the /'a,O2, and no abnormal radiological findings. These results were related to the protective effects of some drugs. The protective effect of disodium cromoglycate and prednisolone is probably the same in both types of late reactions. The protective efFect of antihistamine drugs, which is found in this late obstructive reaction, is, according to the literature, absent in the classical Type III reaction. There seem to be no valid arguments to ascribe the 'late' bronchial obstructive reaction to the toxic complex syndrome.Theoretical and practical itiiplications of the late obstructive bronchial reaction are rnentioned.