Stable COPD: predicting benefit from high-dose inhaled corticosteroid treatment

Leigh, Richard; Pizzichini, Márcia Margaret Menezes; Morris, Marilyn M.; Maltais, François; Hargreave, Frederick E.; Pizzichini, Emílio

doi:10.1183/09031936.06.00072105

Cited by 241 publications

(210 citation statements)

References 36 publications

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“…The present results indicate a preferential distribution of eosinophils towards the lumen. This may have implications for current and future treatment strategies [41][42][43][44] in chronic obstructive pulmonary disease patients with clinical symptoms of chronic bronchitis. …”

Section: Discussionmentioning

confidence: 99%

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Chronic bronchitis sub-phenotype within COPD: inflammation in sputum and biopsies

Snoeck-Stroband

Lapperre²,

Gosman³

et al. 2008

European Respiratory Journal

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The presence of chronic bronchitis predicts a more rapid decline of forced expiratory volume in one second (FEV1) in patients with chronic obstructive pulmonary disease (COPD). The hallmark of COPD is airway inflammation. It was hypothesised that COPD patients with chronic bronchitis are characterised by a distinct inflammatory cell profile, as measured in bronchial biopsies and sputum.From 114 COPD patients (male/female ratio 99/15, mean¡SD age 62¡8 yrs, current smoking 63%, post-bronchodilator FEV1 63¡9% predicted, no steroids), with and without chronic bronchitis, inflammatory cell counts in bronchial biopsies and induced sputum were measured. Analysis was carried out by logistic regression.COPD patients with chronic bronchitis had lower eosinophil counts in biopsies and higher percentages of sputum eosinophils than patients without those symptoms, which remained after adjustment for smoking and sex. Patients with chronic bronchitis also showed higher percentages of macrophages and lower percentages of neutrophils in sputum, which could be explained by differences in smoking and sex.It was concluded that chronic bronchitis reflects an inflammatory sub-phenotype among patients with chronic obstructive pulmonary disease. The present results indicate a preferential distribution of eosinophils towards the airway lumen in patients with chronic bronchitis. This may have implications for anti-inflammatory treatment of chronic obstructive pulmonary disease patients with chronic bronchitis.

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Section: Discussionmentioning

confidence: 99%

“…Previous studies showed that treatment with steroids may reduce numbers of sputum eosinophils in patients with COPD [40,41], whereas sputum eosinophilia in COPD may be predictive of a clinical response to steroid treatment [42,43]. Distinct inflammatory cell profiles may require different (antiinflammatory) interventions.…”

Section: Discussionmentioning

confidence: 99%

Chronic bronchitis sub-phenotype within COPD: inflammation in sputum and biopsies

Snoeck-Stroband

Lapperre²,

Gosman³

et al. 2008

European Respiratory Journal

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“…COPD with concomitant asthma has been associated with more eosinophilic inflammation, as shown by more peripheral and sputum eosinophils [Kitaguchi et al 2012;Papi et al 2000], and in addition, these patients responded better to ICS [Brightling et al 2005;Kerstjens et al 1993;Kitaguchi et al 2012;Leigh et al 2006]. Iwamoto showed increased sputum eosinophilia in patients with asthma and ACOS compared with healthy smokers and those with COPD [Iwamoto et al 2014].…”

Section: Airway Inflammationmentioning

confidence: 99%

Asthma and chronic obstructive pulmonary disease overlap: asthmatic chronic obstructive pulmonary disease or chronic obstructive asthma?

Slats

Taube

2015

Ther Adv Respir Dis

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Asthma and chronic obstructive pulmonary disease (COPD) are different disease entities. They are both clinical diagnoses, with diagnostic tools to discriminate between one another. However, especially in older patients (>55 years) it seems more difficult to differentiate between asthma and COPD. This has led to the definition of a new phenotype called asthma COPD overlap syndrome (ACOS). However, our understanding of ACOS is at a very preliminary stage, as most research has involved subjects with existing diagnoses of asthma or COPD from studies with different definitions for ACOS. This has led to different and sometimes opposing results between studies on several features of ACOS, also depending on the comparison with COPD alone, asthma alone or both, which are summarized in this review.We suggest not using the term ACOS for a patient with features of both asthma and COPD, but to describe a patient with chronic obstructive airway disease as completely as possible, with regard to characteristics that determine treatment response (e.g. eosinophilic inflammation) and prognosis (such as smoking status, exacerbation rate, fixed airflow limitation, hyperresponsiveness, comorbidities). This will provide a far more clinically relevant diagnosis, and would aid in research on treatment in more homogenous groups of patients with chronic airways obstruction. More research is certainly needed to develop more evidence-based definitions for this patient group and to evaluate biomarkers, which will help to further classify these patients, treat them more adequately and unravel the underlying pathophysiological mechanism.

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“…Taken together, these findings suggest that the airway structural changes can impair respiratory function and aggravate asthmatic symptoms even in patients with mild asthma. Although inhalation of steroids can inhibit airway inflammation in asthma, it is still unclear whether it can reverse airway structural changes [30] . Our research found that inhalation of budesonide-ormoterol for one year could effectively alleviate asthma symptoms, improve lung function, reduce airway hyper-responsiveness, inhibit inflammatory cell infiltration, and reverse airway remodeling in patients with asthma.…”

Section: Discussionmentioning

confidence: 99%

Effects of formoterol-budesonide on airway remodeling in patients with moderate asthma

Wang

Liu

et al. 2010

Acta Pharmacol Sin

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Aim: To evaluate the effect of inhaled formoterol-budesonide on airway remodeling in adult patients with moderate asthma. Methods: Thirty asthmatic patients and thirty control subjects were enrolled. Asthmatic subjects used inhaled Symbicort 4.5/160 µg twice daily for one year. The effect of formoterol-budesonide on airway remodeling was assessed with comparing high-resolution computer tomography (HRCT) images of asthmatic patients and controls, as well as expression levels of cytokines and growth factors, inflammatory cell count in induced sputum, and airway hyper-responsiveness. Results: The differences in age and gender between the two groups were not significant. However, differences in FVC %pred, FEV 1 %pred, and PC 20 between the two groups were significant. After treatment with formoterol-budesonide, the asthma patients' symptoms were relieved, and their lung function was improved. The WT and WA% of HRCT images in patients with asthma was increased, whereas treatment with formoterol-budesonide caused these values to decrease. The expression of MMP-9, TIMP-1, and TGF-β 1 in induced sputum samples increased in patients with asthma and decreased dramatically after treatment with formoterol-budesonide. The WT and WA% are correlated with the expression levels of cytokines and growth factors, inflammatory cell count in induced sputum, and airway hyper-responsiveness, while these same values are correlated negatively with FEV 1 /FVC and FEV 1 %. Conclusion: Formoterol-budesonide might interfere in chronic inflammation and airway remodeling in asthmatic patients. HRCT can be used to effectively evaluate airway remodeling in asthmatic patients.

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Stable COPD: predicting benefit from high-dose inhaled corticosteroid treatment

Cited by 241 publications

References 36 publications

Chronic bronchitis sub-phenotype within COPD: inflammation in sputum and biopsies

Chronic bronchitis sub-phenotype within COPD: inflammation in sputum and biopsies

Asthma and chronic obstructive pulmonary disease overlap: asthmatic chronic obstructive pulmonary disease or chronic obstructive asthma?

Effects of formoterol-budesonide on airway remodeling in patients with moderate asthma

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