Background: Exacerbations are an important feature of chronic obstructive pulmonary disease (COPD), accounting for a large proportion of health care costs. They are associated with increased airway inflammation and oxidative stress. Methods: Concentrations of leukotriene B4 (LTB4), a marker of inflammation, and 8-isoprostane, a marker of oxidative stress, were measured in the exhaled breath condensate of 21 patients (11 M) with COPD during an exacerbation and 2 weeks after treatment with antibiotics. In 12 patients who had no further exacerbations these markers were also measured after 2 months. Results: LTB4 concentrations were raised during the COPD exacerbation (mean (SE) 15.8 (1.1) pg/ml and fell after treatment with antibiotics to 9.9 (0.9) pg/ml (p<0.0001). In 12 patients the level of LTB4 fell further from 10.6 (1.1) pg/ml to 8.5 (0.8) pg/ml (p<0.005) after 2 months. In 12 normal age matched subjects the LTB4 levels were 7.7 (0.5) pg/ml. Concentrations of 8-isoprostane were also increased during the exacerbation (13.0 (0.9) pg/ml) and fell after antibiotic treatment to 9.0 (0.6) pg/ml (p<0.0001). In 12 patients there was a further fall from 9.3 (0.7) pg/ml to 6.0 (0.7) pg/ ml (p<0.001) after 2 months compared with normal subjects (6.2 (0.4) pg/ml). Conclusions: Non-invasive markers of inflammation and oxidative stress are increased during an infective exacerbation of COPD and only slowly recover after treatment with antibiotics.

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Previous studies of acupuncture in asthma have reported conflicting results, some claiming benefit for some patients. We conducted a randomized, double-blind (patient and evaluator) study in 23 non-smoking asthmatics (10 M; 13 F) aged 43 +/- 15 years with forced expiratory volume in 1 s (FEV1) 59 +/- 16% pred. After initial assessment (respiratory function tests and Asthma Quality Life Questionnaire) patients were randomized to receive either 'real' or 'sham' acupuncture. The measurements were repeated within 1 h and after 2 weeks. Patients were recording peak expiratory flow rate (PEFR) throughout the period of the study. After 2 weeks patients who received 'real' treatment on the first visit received 'sham' treatment and vice versa. The measurements were again repeated within 1 h and after 2 weeks. There was no improvement in any aspects of respiratory function measured after either form of acupuncture. Despite this there was a significant improvement in AQLQ and parallel reduction in the usage of bronchodilators. We concluded that in some patients acupuncture could be useful in improving quality of life and reducing the need for using bronchodilators either by having a placebo effect or that the exact site of needle puncture on the chest is unimportant.

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