title: Inhaled corticosteroids do not influence the early inflammatory response and clinical presentation of hospitalized subjects with COPD exacerbation.
abstract: BACKGROUND
  Inhaled corticosteroids are anti-inflammatory medications that can down-regulate the immunologic response in patients with COPD; however, their role at onset of COPD exacerbation is still not understood. The aim of this study was to assess the early inflammatory response and clinical presentation of patients with COPD exacerbation mediated by inhaled corticosteroids.
  
  
  METHODS
  Prospective data were collected on 123 hospitalized subjects with COPD exacerbation over a 30-month period at 2 Spanish university hospitals. Based on domiciliary use, comparative analyses were performed between subjects who did not use inhaled corticosteroids (n = 58) and subjects who did (n = 65). Measurements of serum biomarkers were recorded on admission to the hospital (day 1) and on day 3; clinical, physiological, microbiological, and severity data and mortality/readmission rates were also recorded.
  
  
  RESULTS
  At days 1 and 3, both groups showed a similar inflammatory response; fluticasone produced lower levels of interleukin-8 compared with budesonide (P < .01). All clinical features considered were similar in the 2 groups; multivariate analysis predicting clinical complications on hospitalization showed air-flow obstruction severity as the only predictive factor (odds ratio 3.13, 95% CI 1.13-8.63, P = .02).
  
  
  CONCLUSIONS
  Our study demonstrates a lack of inhaled corticosteroid influence in the early systemic inflammatory response to and clinical presentation of COPD exacerbation.
authors: Cardio-Thoracic Department, Pneumology and Respiratory Intensive Care Unit, Carlo Poma Hospital, Mantua, Italy.
authors: Ernesto
authors: E
authors: Crisafulli
authors: Pneumology Department, Clinic Institute of Thorax, Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain.
authors: Mónica
authors: M
authors: Guerrero
authors: Pneumology Department, Hospital Universitario y Politecnico La Fe, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Valencia, Spain.
authors: Rosario
authors: R
authors: Menéndez
authors: Pneumology Department, Clinic Institute of Thorax, Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain.
authors: Arturo
authors: A
authors: Huerta
authors: Pneumology Department, Hospital Universitario y Politecnico La Fe, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Valencia, Spain.
authors: Raquel
authors: R
authors: Martinez
authors: Pneumology Department, Hospital Universitario y Politecnico La Fe, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Valencia, Spain.
authors: Alexandra
authors: A
authors: Gimeno
authors: Pneumology Department, Clinic Institute of Thorax, Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain.
authors: Néstor
authors: N
authors: Soler
authors: Pneumology Department, Clinic Institute of Thorax, Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain. atorres@clinic.ub.es.
authors: Antoni
authors: A
authors: Torres
mesh_terms: D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D000368:Aged; D000730:Androstadienes / Q000008:administration & dosage*; D015415:Biomarkers / Q000097:blood; D019819:Budesonide / Q000008:administration & dosage*; D015897:Comorbidity; D005260:Female; D000068298:Fluticasone; D006760:Hospitalization; D006801:Humans; D016209:Interleukin-8 / Q000097:blood; D008297:Male; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy* / Q000276:immunology* / Q000503:physiopathology; D012720:Severity of Illness Index; D013030:Spain
chemical_list: D000305:Adrenal Cortex Hormones; D000730:Androstadienes; D015415:Biomarkers; D016209:Interleukin-8; D019819:Budesonide; D000068298:Fluticasone
keywords: chronic obstructive pulmonary disease; clinical presentation; exacerbation; inhaled corticosteroids; systemic inflammation