Budesonide/Formoterol Therapy Increases FEV1 in Stem Cell Transplant–associated Bronchiolitis Obliterans Syndrome

Abstract

to antibiotics in the treatment of community-acquired pneumonia did not show a benefit in clinically important outcomes such as all-cause mortality, in preventing ICU admission and hospital readmission, and in reducing recurrent pneumonia. Trials should evaluate these endpoints in the future. In addition, future trials should consider whether prednisone should be restricted to selected populations such as those with more severe illness and those with high levels of inflammation. REFERENCES1. Confalionieri M, Urbino R, Potena A, et al. Hydrocortisone infusion for severe community-acquired pneumonia: a preliminary randomized study. Am J Resp Crit Care Med. 2005;171:242-248. 2. Garcia-Viadal C, Calbo E, Pascual V, et al. Effects of systemic steroids in patient with severe community-acquired pneumonia. Eur Respir J. 2007;30:951-956. 3. Meijvis SC, Hardeman H, Remmelts HH, et al. Dexamethasone and length of hospital stay in patients with community-acquired pneumonia: randomized, double-blind, placebo-controlled trial. Lancet. 2011;377:2023-2030. 4. Snijders D, Daniels JM, De Graff SC, et al. Efficacy of corticosteroids in community-acquired pneumonia: a randomized, doubleblinded clinical trial. Am J Resp Crit Care Med. 2010;181: 975-982. 5. Torres A, Sibila O, Ferrer M, et al. Effect of corticosteroids on treatment failure among hospitalized patients with severe community-acquired pneumonia and high inflammatory response: a randomized clinical trial. JAMA. 2015;313:677-686. 6. Nie W, Zhang Y, Cheng J, et al. Corticosteroids in the treatment of community-acquired pneumonia in adults: a meta-analysis. PLoS One. 2010;7:e47926. 7. Lamontagne F, Briel M, Guyatt GH, et al. Corticosteroid therapyfor acute lung injury, acute respiratory distress syndrome, and severe pneumonia: a meta-analysis of randomized controlled trials. Synopsis:In patients with mild to severe bronchiolitis obliterans syndrome after allogeneic hematopoietic stem cell transplantation, the administration of inhaled budesonide\formoterol led to a significant improvement in FEV 1 .B ronchiolitis obliterans syndrome (BOS) after allogeneic hematopoietic stem cell transplantation (HSCT) is a clinical syndrome characterized by airflow obstruction, with a reported incidence as high as 30%. 1 The pathogenesis is believed to be analogous with pulmonary graft-versus-host disease and is often treated with systemic corticosteroids despite the lack of evidence supporting their effectiveness. 2 Azithromycin has been shown to improve lung function after 3 months of therapy in BOS complicating lung transplantation; however, a similar effect on the forced expiratory volume in 1 second (FEV 1 ) is not observed in patients with BOS after HSCT. Despite this lack of efficacy, azithromycin is commonly used to treat this disorder. 3,4 Motivated by the lack of effective therapeutic strategies, the aim of this study was to assess the effect of inhaled budesonide/formoterol on the pulmonary function test (PFT) results of patients with mild to severe BOS after allogeneic HSCT. This ...