Inhaled Corticosteroids May Reduce Neutrophilic Inflammation in Patients with Stable Chronic Obstructive Pulmonary Disease

Abstract

Background: Although both inhaled and oral corticosteroids have anti-inflammatory effects causing improvement in clinical symptoms and spirometry in the treatment of asthma, the role of corticosteroids in the management of chronic obstructive pulmonary disease (COPD) is controversial. Objective: To evaluate the effects of inhaled corticosteroids on sputum neutrophilia in clinically stable COPD patients. Methods: In total, 18 patients were enrolled in the study. During 2 months, 9 patients in group A inhaled fluticasone propionate (FP) 500 μg 3 times daily. In group B 9 patients received placebo. All of the patients continued to inhale both salbutamol and ipratropium bromide. In 9 patients, sustained-released theophylline was also administered. Blood samples, spirometric tests, blood gas analyses, and either spontaneous or induced sputum cultures were evaluated on entry into the study, after a 2 months of treatment and following the 6-week washout period. Results: After the 2-month FP treatment, no significant changes in the number of peripheral blood neutrophils, blood gas and spirometry data were observed in both groups. In group A, the total cell number and the number of neutrophils decreased from a mean of 3.4 ± 1.3 × 10⁶ cells/g and 0.6 ± 0.3 × 10⁶ neutrophils/g on entry into study to 1.9 ± 0.6 × 10⁶ cells/g and 0.02 ± 0.01 × 10⁶ neutrophils/g after 8-week treatment with FP, returning to 3.3 ± 1.1 × 10⁶ cells/g and 0.5 ± 0.3 × 10⁶ neutrophils/g following the washout period. The percentages of neutrophils were 55.6 and 77.9% in groups A and B after 2 months of FP treatment. There was no significant change in group B values during the study. Conclusion: These data suggest that neutrophilic inflammation in sputum may be decreased by inhaled corticosteroids in clinically stable COPD patients.

Pneumonia risk in COPD patients receiving inhaled corticosteroids alone or in combination: TORCH study results

“…Conversely, there are no reports of excess pneumonia AEs with ICS use in randomised clinical trials in asthmatics. Although corticosteroids are felt to be less effective in modulating neutrophil function compared with other effector cells, such as eosinophils or mast cells [28], several reports suggest that ICScontaining regimens may reduce sputum neutrophilia in patients with COPD [29,30], perhaps by decreasing neutrophil chemotaxis [31]. However, there is some evidence that SAL may alter neutrophil function either through decreased adhesion to airway epithelium [32] or capillary endothelium [33] or by inhibiting respiratory burst activity [34]; yet an increase in the pneumonia signal was not observed with SAL therapy in this trial.…”

Inhaled corticosteroids and survival in chronic obstructive pulmonary disease: does the dose matter?

“…The mechanisms underlying these observations remain largely unknown. Although corticosteroids are less effective at neutralising COPDrelated airway inflammation than that occurring in asthma, several [25][26][27], but not all [28,29], studies have demonstrated that therapy with moderate-to-high doses of inhaled corticosteroids for several weeks can significantly attenuate some of the components of airway inflammation in COPD. Inhaled corticosteroids may also attenuate airway hyperresponsiveness [11], a known risk factor for morbidity and mortality in COPD [30].…”

Nitric Oxide and Exhaled Breath Nitrite/Nitrates in Chronic Obstructive Pulmonary Disease Patients

“…One study showed eNO to be elevated in current smokers with COPD when compared with otherwise healthy smokers, while EBC NOx has been described as being the same as in healthy smokers or increased when compared with healthy non-smokers [11]. COPD-associated airway inflammation may be affected by multiple factors, including cigarette smoking and GCS treatment [12, 13]. …”