title: Bronchoalveolar lavage cellular profiles in lung transplantation: the effect of inhaled corticosteroids.
abstract: Bronchiolitis Obliterans Syndrome (BOS) remains a major cause of long term morbidity and mortality in lung transplantation, and occurs despite significant immunosuppression. Airway inflammation is thought to precede the development of BOS.
  
  
  OBJECTIVE
  To examine the effect of inhaled corticosteroids on airway inflammation and the development of BOS in lung transplant recipients.
  
  
  METHODS
  30 patients were recruited and randomised in a double blind fashion to receive either 750 micrograms Fluticasone propionate (FP) twice daily or an identical appearing placebo for 3 months. BAL cell counts and differentials were performed at time 0 and after 3 months treatment. Lung function was assessed at each time point using spirometry.
  
  
  RESULTS
  24 patients were felt to be stable and free from infection at both time points and thus included in the analysis. There was a significant reduction in total cell count in BAL fluid after treatment with 3 months FP compared to 3 months placebo, however no change in cell differentials nor lung function was found.
  
  
  CONCLUSIONS
  Despite a reduction in total cell numbers in BAL fluid, lung function was not altered over the 3 months of treatment. It may be that longer treatment is required to see an effect.
authors.affiliation: Department of Respiratory Medicine, Alfred Hospital and Monash Medical School, Commercial Road, Prahran, Victoria, Australia.
authors.forename: H
authors.initials: H
authors.lastname: Whitford
authors.forename: B
authors.initials: B
authors.lastname: Orsida
authors.forename: T
authors.initials: T
authors.lastname: Kotsimbos
authors.forename: M
authors.initials: M
authors.lastname: Pais
authors.forename: C
authors.initials: C
authors.lastname: Ward
authors.forename: L
authors.initials: L
authors.lastname: Zheng
authors.forename: T
authors.initials: T
authors.lastname: Williams
authors.forename: E H
authors.initials: EH
authors.lastname: Walters
authors.forename: G
authors.initials: G
authors.lastname: Snell
mesh_terms: D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D000328:Adult; D001989:Bronchiolitis Obliterans / Q000209:etiology / Q000473:pathology / Q000517:prevention & control; D001992:Bronchoalveolar Lavage Fluid / Q000166:cytology*; D002452:Cell Count; D004311:Double-Blind Method; D005541:Forced Expiratory Volume; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D007249:Inflammation / Q000209:etiology / Q000473:pathology / Q000517:prevention & control; D016040:Lung Transplantation / Q000009:adverse effects / Q000473:pathology* / Q000502:physiology; D008875:Middle Aged; D011446:Prospective Studies
chemical_list: D000305:Adrenal Cortex Hormones; D007166:Immunosuppressive Agents