Reducing agents decrease the oxidative burst and improve clinical outcomes in COPD patients: a randomised controlled trial on the effects of sulphurous thermal water inhalation.
BACKGROUND
Inhalation of thermal water with antioxidant properties is empirically used for COPD.


OBJECTIVE
To evaluate the effects of sulphurous thermal water (reducing agents) on airway oxidant stress and clinical outcomes in COPD.


METHODS
Forty moderate-to-severe COPD patients were randomly assigned to receive 12-day inhalation with sulphurous thermal water or isotonic saline. Patients were assessed for superoxide anion (O2 (-)) production in the exhaled breath condensate and clinical outcomes at recruitment, the day after the conclusion of the 12-day inhalation treatment, and one month after the end of the inhalation treatment.


RESULTS
Inhalation of reducing agents resulted in a significant reduction of O2 (-) production in exhaled breath condensate of COPD patients at the end of the inhalatory treatment and at followup compared to baseline. A significant improvement in the COPD assessment test (CAT) questionnaire was shown one month after the end of the inhalatory treatment only in patients receiving sulphurous water.


CONCLUSIONS
Thermal water inhalation produced an in vivo antioxidant effect and improvement in health status in COPD patients. Larger studies are required in order to evaluate whether inhalation of thermal water is able to modify relevant clinical outcomes of the disease (the study was registered at clinicaltrial.gov-identifier: NCT01664767).
Department of Medical Sciences, Research Centre on Asthma and COPD, University of Ferrara, Via Savonarola 9, 44121 Ferrara, Italy.
Marco
M
Contoli
Department of Medical Sciences, Research Centre on Asthma and COPD, University of Ferrara, Via Savonarola 9, 44121 Ferrara, Italy.
Giulia
G
Gnesini
Department of Medical Sciences, Research Centre on Asthma and COPD, University of Ferrara, Via Savonarola 9, 44121 Ferrara, Italy.
Giacomo
G
Forini
Department of Medical Sciences, Research Centre on Asthma and COPD, University of Ferrara, Via Savonarola 9, 44121 Ferrara, Italy.
Brunilda
B
Marku
Department of Medical Sciences, Research Centre on Asthma and COPD, University of Ferrara, Via Savonarola 9, 44121 Ferrara, Italy.
Alessia
A
Pauletti
Department of Medical Sciences, Research Centre on Asthma and COPD, University of Ferrara, Via Savonarola 9, 44121 Ferrara, Italy.
Anna
A
Padovani
Department of Medical Sciences, Research Centre on Asthma and COPD, University of Ferrara, Via Savonarola 9, 44121 Ferrara, Italy.
Paolo
P
Casolari
Department of Medical Sciences, Research Centre on Asthma and COPD, University of Ferrara, Via Savonarola 9, 44121 Ferrara, Italy.
Liliana
L
Taurino
Department of Medical Sciences, Research Centre on Asthma and COPD, University of Ferrara, Via Savonarola 9, 44121 Ferrara, Italy.
Andrea
A
Ferraro
Department of Life Science and Biotechnology, University of Ferrara, Via Savonarola 9, 44121 Ferrara, Italy.
Milva
M
Chicca
Department of Medical Sciences, Research Centre on Asthma and COPD, University of Ferrara, Via Savonarola 9, 44121 Ferrara, Italy.
Adalberto
A
Ciaccia
Department of Medical Sciences, Research Centre on Asthma and COPD, University of Ferrara, Via Savonarola 9, 44121 Ferrara, Italy.
Alberto
A
Papi
Department of Life Science and Biotechnology, University of Ferrara, Via Savonarola 9, 44121 Ferrara, Italy.
Silvano
S
Pinamonti
D000280:Administration, Inhalation; D000368:Aged; D000369:Aged, 80 and over; D000975:Antioxidants / Q000627:therapeutic use; D001944:Breath Tests; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy* / Q000503:physiopathology; D019163:Reducing Agents / Q000627:therapeutic use*; D016897:Respiratory Burst / Q000187:drug effects*; D012129:Respiratory Function Tests; D013455:Sulfur / Q000008:administration & dosage*; D016896:Treatment Outcome; D014867:Water
D000975:Antioxidants; D019163:Reducing Agents; D014867:Water; D013455:Sulfur