Effects of Inhaled Corticosteroids with Different Lung Deposition on Exhaled Hydrogen Peroxide in Stable COPD Patients

Abstract

Background: The effects of inhaled corticosteroids (ICS) on markers of oxidative stress in patients with stable COPD are unclear. Objectives: The aim was to investigate the effect of ICS on exhaled H₂O₂ in stable COPD patients and to compare ICS with different lung deposition. Methods: Forty-one stable patients with moderate COPD (FEV₁ ∼60% predicted) were randomized to sequence 1; first HFA-134a beclomethasone dipropionate (HFA-BDP, an ICS with more peripheral deposition) 400 µg b.i.d., then fluticasone propionate (FP, an ICS with more central deposition) 375 µg b.i.d. (n = 20) or sequence 2 ; first FP, then HFA-BDP (n = 21). Both 4-week treatment periods were preceded by a 4-week washout period. After each period, the concentration of H₂O₂ in exhaled breath condensate was measured. Results: The H₂O₂ concentration decreased significantly after the first treatment period in both sequence 1 and 2 (p < 0.05, p = 0.01, respectively). In neither sequence was there a return to baseline values after the second washout, indicating a carry-over effect. The concentrations remained low in both sequences during the second treatment period. Conclusions: Both ICS appeared to reduce exhaled H₂O₂ in stable COPD patients. However, this study showed no difference between ICS with different deposition patterns, which in part may be due to the carry-over effect.

Oxidative Stress Levels in Exhaled Breath Condensate Associated With COPD and Smoking

“…21 In contrast, another study reported that ICSs reduced exhaled H 2 O 2 in subjects with stable COPD. 22 In our study, COPD subjects receiving ICS therapy had similar H 2 O 2 values, compared with steroid-naive subjects. According to this result, one might conceive that ICSs suppress inflammatory processes contributing to alleviation of oxidative stress.…”

“…22 ICS or oral steroids significantly reduce the chemotactic activity of neutrophils and increase the neutrophil elastase inhibitory capacity in induced sputum. 23,24 In addition, evidence from in vitro studies suggests that among the anti-inflammatory actions of steroids there is a reduction in the generation of ROS by neutrophils.…”

Exhaled breath condensate: methodological recommendations and unresolved questions

“…In COPD patients with exacerbations, higher levels of expired H 2 O 2 were found than in patients in stable condition [45]. Inhaled steroids had no effect on H 2 O 2 level in this disease in some studies [45,74], but caused a decrease in another investigation [89]. Long-term antioxidant treatment with N-acetylcysteine decreased exhaled H 2 O 2 concentration in patients with COPD [75].…”

Antioxidant properties of N-acetylcysteine: their relevance in relation to chronic obstructive pulmonary disease

“…Biopsy studies showed a reduction in the number of mast cells by ICS [32]. Treatment with ICS reduces the concentration of exhaled NO [33] and H 2 O 2 [34] in exhaled air. Recent placebo-controlled trials show no effect of prolonged treatment on the course of forced expiratory volume in one second (FEV1) in mild COPD [35][36][37][38].…”