It is obvious from the above that far too few data exist for a satisfactory answer to be given to this important question. In the studies described above, doses were high in comparison with the doses generally used to treat asthma.
No dosing studies exist, and it therefore seems reasonable to treat patients with doses similar to those tested in the published trials if treatment with ICS is found to be indicated. Doses should therefore approximate to 1 mg of fluti-casone per day, or equipotent doses of other inhaled corticosteroids. In the two most positive studies [12,15], the ICS were administered in MDIs using a spacer device. There are comparative studies with dry powder inhalers in asthma, but this is not the case in COPD. If a device other than an MDI plus spacer is used, it therefore seems crucial that a minimum inhalation technique should be taught properly to ensure maximal effectiveness of the device chosen.
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