title: Inhaled fluticasone reduces sputum inflammatory indices in severe bronchiectasis.
abstract: Although corticosteroid therapy might be clinically beneficial for bronchiectasis, very little is known of its effects on the inflammatory and infective markers in bronchiectasis. We have therefore performed a double-blind, placebo-controlled study to evaluate the effects of a 4-wk administration of inhaled fluticasone in bronchiectasis. Twenty-four patients (12 female; mean age 51 yr) were randomized into receiving either inhaled fluticasone (500 microgram twice daily) via the Accuhaler device (n = 12) or placebo. At each visit, spirometry, 24-h sputum volume, sputum leukocyte density, bacterial densities, and concentrations of interleukin (IL)-1beta, IL-8, tumor necrosis factor-alpha (TNF-alpha), and leukotriene B4 (LTB4) were determined. There was a significant (p < 0.05) decrease in sputum leukocyte density and IL-1beta, IL-8, and LTB4 after fluticasone treatment. The fluticasone group had one and the placebo group three episodes of exacerbation. There were no significant changes in spirometry (p > 0.05) or any reported adverse reactions in either group. The results of this study show that high-dose fluticasone is effective in reducing the sputum inflammatory indices in bronchiectasis. Large-scale and long-term studies are indicated to evaluate the effects of inhaled steroid therapy on the inflammatory components in bronchiectasis.
authors.affiliation: University Departments of Medicine, Microbiology, Pediatrics, and Diagnostic Radiology, Queen Mary Hospital, The University of Hong Kong, Hong Kong.
authors.forename: K W
authors.initials: KW
authors.lastname: Tsang
authors.forename: P L
authors.initials: PL
authors.lastname: Ho
authors.forename: W K
authors.initials: WK
authors.lastname: Lam
authors.forename: M S
authors.initials: MS
authors.lastname: Ip
authors.forename: K N
authors.initials: KN
authors.lastname: Chan
authors.forename: C S
authors.initials: CS
authors.lastname: Ho
authors.forename: C C
authors.initials: CC
authors.lastname: Ooi
authors.forename: K Y
authors.initials: KY
authors.lastname: Yuen
mesh_terms: D000280:Administration, Inhalation; D000287:Administration, Topical; D000328:Adult; D000730:Androstadienes / Q000008:administration & dosage / Q000627:therapeutic use*; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001987:Bronchiectasis / Q000188:drug therapy* / Q000276:immunology / Q000382:microbiology / Q000473:pathology; D004311:Double-Blind Method; D005260:Female; D000068298:Fluticasone; D005541:Forced Expiratory Volume / Q000187:drug effects; D005938:Glucocorticoids; D006801:Humans; D007249:Inflammation; D007375:Interleukin-1 / Q000032:analysis; D016209:Interleukin-8 / Q000032:analysis; D007958:Leukocyte Count / Q000187:drug effects; D007975:Leukotriene B4 / Q000032:analysis; D008297:Male; D008875:Middle Aged; D009330:Nebulizers and Vaporizers; D010366:Peak Expiratory Flow Rate / Q000187:drug effects; D010919:Placebos; D011550:Pseudomonas aeruginosa / Q000302:isolation & purification; D013183:Sputum / Q000166:cytology / Q000187:drug effects* / Q000276:immunology / Q000382:microbiology; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis; D014797:Vital Capacity / Q000187:drug effects
chemical_list: D000730:Androstadienes; D000893:Anti-Inflammatory Agents; D005938:Glucocorticoids; D007375:Interleukin-1; D016209:Interleukin-8; D010919:Placebos; D014409:Tumor Necrosis Factor-alpha; D007975:Leukotriene B4; D000068298:Fluticasone