Inhaled corticosteroids may reduce neutrophilic inflammation in patients with stable chronic obstructive pulmonary disease.
BACKGROUND
Although both inhaled and oral corticosteroids have anti-inflammatory effects causing improvement in clinical symptoms and spirometry in the treatment of asthma, the role of corticosteroids in the management of chronic obstructive pulmonary disease (COPD) is controversial.


OBJECTIVE
To evaluate the effects of inhaled corticosteroids on sputum neutrophilia in clinically stable COPD patients.


METHODS
In total, 18 patients were enrolled in the study. During 2 months, 9 patients in group A inhaled fluticasone propionate (FP) 500 microg 3 times daily. In group B 9 patients received placebo. All of the patients continued to inhale both salbutamol and ipratropium bromide. In 9 patients, sustained-released theophylline was also administered. Blood samples, spirometric tests, blood gas analyses, and either spontaneous or induced sputum cultures were evaluated on entry into the study, after a 2 months of treatment and following the 6-week washout period.


RESULTS
After the 2-month FP treatment, no significant changes in the number of peripheral blood neutrophils, blood gas and spirometry data were observed in both groups. In group A, the total cell number and the number of neutrophils decreased from a mean of 3. 4 +/- 1.3 x 10(6) cells/g and 0.6 +/- 0.3 x 10(6) neutrophils/g on entry into study to 1.9 +/- 0.6 x 10(6) cells/g and 0.02 +/- 0.01 x 10(6) neutrophils/g after 8-week treatment with FP, returning to 3.3 +/- 1.1 x 10(6) cells/g and 0.5 +/- 0.3 x 10(6) neutrophils/g following the washout period. The percentages of neutrophils were 55. 6 and 77.9% in groups A and B after 2 months of FP treatment. There was no significant change in group B values during the study.


CONCLUSIONS
These data suggest that neutrophilic inflammation in sputum may be decreased by inhaled corticosteroids in clinically stable COPD patients.
Yildiz
F
F
Department of Pulmonary Medicine, Kocaeli University School of Medicine, Kocaeli, Turkey. yildizfu@superonline.com
Kaur
A C
AC
Ilgazli
A
A
Celikoglu
M
M
Kaçar Ozkara
S
S
Paksoy
N
N
Ozkarakaş
O
O
D000280:Administration, Inhalation; D000368:Aged; D000730:Androstadienes / Q000008:administration & dosage / Q000627:therapeutic use*; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001784:Blood Gas Analysis; D005260:Female; D000068298:Fluticasone; D006801:Humans; D007249:Inflammation / Q000188:drug therapy; D008173:Lung Diseases, Obstructive / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D009504:Neutrophils / Q000187:drug effects; D013147:Spirometry; D013183:Sputum / Q000166:cytology
D000730:Androstadienes; D000893:Anti-Inflammatory Agents; D000068298:Fluticasone