Inhaled fluticasone and salmeterol suppress eosinophilic airway inflammation in chronic obstructive pulmonary disease: relations with lung function and bronchodilator reversibility.
The aim of this study was to determine whether combined inhaled corticosteroids and long-acting beta(2) agonists can suppress eosinophilic inflammation in chronic dostructive plumonary disease (COPD) and to investigate the association between the level of eosinophilia and the degree of bronchodilator reversibility. Sixty-two patients with stable COPD (forced expiratory volume in 1 [FEV(1)] of 30%-70% predicted before bronchodilation) were enrolled from our outpatient clinic. Patients received inhaled fluticasone (100 microg)/salmeterol (50 microg) twice daily for two months. Lung function measurements, bronchodilator tests, and sputum induction were performed. The number of inflammatory cells and mediators, including interleukin-8 (IL-8), tumor necrosis factor-alpha (TNF-alpha), and eosinophilic cationic protein (ECP), were measured. Treatment with inhaled fluticasone and salmeterol significantly suppressed eosinophilic inflammation in COPD patients with sputum eosinophilia (mean 8.9% +/- 2.0% vs. 1.6% +/- 0.5%, p = 0.003), but insignificant differences in FEV(1) and FVC between patients with and without eosinophilia suggested that suppression of eosinophilic inflammation had no effect on FEV(1) or FVC. Reduction in the percentage of eosinophils was significantly correlated with decreased levels of ECP (r = 0.48, p < 0.001). Levels of neutrophils, IL-8, and TNF-alpha were not affected. Sputum eosinophilia was not related to the degree of bronchodilator reversibility. The degree of bronchodilator reversibility did not predict the increase in FEV(1) and FVC after treatment with inhaled corticosteroids/long-acting beta(2) agonists. Suppression of eosinophilic inflammation and bronchodilator responsiveness indices were not correlated with clinical outcomes in COPD patients treated with inhaled corticosteroids/long-acting beta(2) agonists.
Perng
Diahn-Warng
DW
Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan. dwperng@vghtpe.gov.tw
Wu
Cheng-Che
CC
Su
Kang-Cheng
KC
Lee
Yu-Chin
YC
Perng
Reury-Perng
RP
Tao
Chi-Wei
CW
D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D000318:Adrenergic beta-Agonists / Q000008:administration & dosage*; D000368:Aged; D000420:Albuterol / Q000008:administration & dosage / Q000031:analogs & derivatives*; D000730:Androstadienes / Q000008:administration & dosage*; D001993:Bronchodilator Agents / Q000008:administration & dosage*; D004359:Drug Therapy, Combination; D004802:Eosinophilia / Q000188:drug therapy* / Q000209:etiology*; D005260:Female; D000068298:Fluticasone; D005541:Forced Expiratory Volume / Q000187:drug effects; D006801:Humans; D008168:Lung / Q000187:drug effects* / Q000503:physiopathology*; D008297:Male; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000188:drug therapy*; D000068299:Salmeterol Xinafoate; D014797:Vital Capacity / Q000187:drug effects
D000305:Adrenal Cortex Hormones; D000318:Adrenergic beta-Agonists; D000730:Androstadienes; D001993:Bronchodilator Agents; D000068299:Salmeterol Xinafoate; D000068298:Fluticasone; D000420:Albuterol