Long-term effects of inhaled corticosteroids on sputum bacterial and viral loads in COPD

Abstract

Inhaled corticosteroid-containing medications reduce the frequency of COPD exacerbations (mainly infectious in origin) while paradoxically increasing the risk of other respiratory infections The aim was to determine the effects of inhaled corticosteroids on airway microbial load in COPD patients and evaluate the influence of the underlying inflammatory profile on airway colonisation and microbiome.This is a proof-of-concept prospective, randomised, open-label, blinded endpoint study. Sixty patients with stable moderate COPD were randomised to receive one inhalation twice daily of either a combination of salmeterol 50 μg plus fluticasone propionate 500 μg or salmeterol 50 μg for 12 months. The primary outcome was the change of sputum bacterial loads over the course of treatment.Compared with salmeterol, 1-year treatment with salmeterol plus fluticasone was associated with a significant increase in sputum bacterial load (p=0.005), modification of sputum microbial composition and increased airway load of potentially pathogenic bacteria. The increased bacterial load was observed only in inhaled corticosteroid-treated patients with lower baseline sputum or blood eosinophil (≤2%) levels but not in patients with higher baseline eosinophils.Long-term inhaled corticosteroid treatment affects bacterial load in stable COPD. Lower eosinophil counts are associated with increased airway bacterial load.

Inhaled corticosteroids and COVID-19: a systematic review and clinical perspective

“…ICS use in asthma and COPD is associated with an increased risk of upper respiratory tract infections [10,11]. In people with COPD, ICS use is associated with a higher prevalence of pneumonia [12] and a change in the lung microbiome, although not a change in respiratory virus detection [13]. The evidence in asthma is less clear cut, but at least one observational study has shown an increased risk of pneumonia or lower respiratory infection [14].…”

The microbiome in bronchiectasis

“…The field of microbiome research in bronchiectasis is less advanced than the field of other respiratory diseases such as cystic fibrosis and chronic obstructive pulmonary disease (COPD), with fewer published studies [33][34][35][36]. Nevertheless, evidence to date suggests remarkable consistency in findings across supposedly distinct disease entities [37][38][39][40]. The first group of published bronchiectasis microbiome studies have supported the findings of culture-based studies, identifying genera associated with infection such as Haemophilus, Streptococcus and Pseudomonas, while also providing evidence of bacterial pathogens in culture-negative patients [41][42][43].…”

Airway inflammatory profile is correlated with symptoms in stable COPD: A longitudinal proof‐of‐concept cohort study

“…Additional analyses were as follows: (i) the correlation among distinct symptom domains/use of rescue medications; (ii) the correlation of FeNO levels and symptom scores; and (iii) the correlation of lung function with airway inflammation and symptom scores. A post hoc analysis was performed to specifically evaluate correlations between symptom scores and sputum inflammatory cell counts in the subpopulation of COPD patients with sputum eosinophils ≥2% (Appendix S1, Supplementary Information).…”