Airway inflammation and tiotropium treatment in stable COPD patients

Abstract

Background/aim: Chronic obstructive pulmonary disease (COPD) is an inflammatory disease of the lung associated with progressive airflow limitation. The aim of this study is to assess the influence of tiotropium treatment on airway inflammation and symptoms in stable COPD patients.Materials and methods: Inflammatory markers were measured in the expired breath condensate fluid (EBC) before starting tiotropium treatment and at the end of the first month.Results: Twenty-two patients (81% men) with a mean age of 65.4 ± 10.1 years completed the study. The mean nitrotyrosine and 8-isoprostane levels for oxidative stress markers in EBC before and after treatment were 4.5 ± 2.3, 3.5 ± 1.9 pg/mL (P = 0.06) and 7.3 ± 10.8, 8.1 ± 11.7 pg/mL (P = 0.28), respectively. The mean interleukin-6 and tumor necrosis factor-alpha levels for inflammation markers in EBC before and after treatment were 1.03 ± 1.1, 0.77 ± 0.8 pg/mL (P = 0.41) and 27.8 ± 2.6, 29.2 ± 5.7 pg/mL (P = 0.36) respectively. The mean symptom scores decreased significantly with tiotropium and a mean increase of 124.6 ± 0.86 mL was observed in a lung function test (FEV1). Conclusion:Although a 4-week treatment with tiotropium did not modify any of the inflammatory or oxidative stress markers in EBC fluid, tiotropium treatment helps to control symptoms in COPD.

Increased Exhaled 8‐Isoprostane and Interleukin‐6 in Patients with Helicobacter pylori Infection

“…Generally, in many disease states, oxidative stress increases the formation of nitrotyrosine . EBC nitrotyrosine levels were measured in many previous studies, and its increased concentration in EBC was considered to be an indicator of excessive oxidative and nitrosative stress in the airway or lung parenchyma . Although the increases in exhaled nitrotyrosine are not statistically significant in the present study, the slight increases in nitrotyrosine levels are likely caused by the nitrosative and oxidative stresses in the airway of patients due to the systemic effects caused by H. pylori infection in the gastric mucosa.…”

Exhaled breath condensate in chronic obstructive pulmonary disease: methodological challenges and clinical application

“…55 Treatment with tiotropium did not affect exhaled IL-6 levels. 74 Similar 25 and lower 55 levels of IL-8 were reported in stable COPD compared to health. There was a significant correlation between IL-8 and lung function in one study but another reported no correlation.…”

“…72 Mediator concentration did not change following inhaled treatment with either corticosteroid 73 or tiotropium. 74 The level of MDA was increased in COPD compared to controls and also in relation to patients with asthma and bronchiectasis, 52,63 and significantly correlated with lung function in COPD. 63 However, other studies reported no difference.…”

“…Cytokine concentration did not correlate with lung function 82,85 and there was no difference in TNF-α in emphysema-dominant and non-emphysematous COPD patients. 62 Treatment with tiotropium 74 did not affect TNF-α levels in COPD patients. Furthermore, increased and unchanged concentrations of TNF-α were also reported during exacerbation.…”

The Impact of Muscarinic Receptor Antagonists on Airway Inflammation: A Systematic Review

“…Four weeks of treatment with TIO 18 μg reduced the synthesis of LTB 4 by blood neutrophils activated with formyl-L-methionyl-L-leucyl-phenylalanine and primed with GM-CSF, 56 with no reduction in the release of IL-6 and TNF-α in the exhaled breath condensate of stable COPD patients. 57 …”