The effect of inhaled corticosteroids on bronchoalveolar lavage cells and IL-8 levels in stable COPD patients

Abstract

Chronic obstructive pulmonary disease (COPD) is characterised by a chronic inflammatory process in the large and small airways, as well as in the lung parenchyma. Although the role of oral corticosteroids in the management of acute exacerbations of COPD is well documented, its role in stable COPD is not clear. We examined the anti-inflammatory effect of inhaled budesonide on the percentage of neutrophils and on interleukin-8 (IL-8) levels in bronchoalveolar lavage (BAL) and their correlation with spirometry and symptom scores. Twenty-six patients with stable COPD were randomised, in a double-blinded, placebo-controlled trial with either 800 microg of inhaled budesonide or placebo for a 6-month period. The budesonide-treated subjects had significant reductions in IL-8 levels in the BAL after therapy (mean+/-sem, 1.53+/-0.72 at baseline vs. 0.70+/-0.48 ng/ml at 6 months, P=0.004) and a reduction in the mean percentages of neutrophils (17.16+/-2.67% vs. 13.25+/-2.28% P=0.002). The improvement in sputum production was of borderline (P=0.058) significance but there was no improvement in lung function. In stable patients with COPD, treatment with inhaled budesonide for a period of 6 months has a positive effect on markers of lung inflammation, as assessed by reduction in percentage neutrophils and IL-8 concentration in BAL.

Management of chronic obstructive pulmonary disease: Moving beyond the asthma algorithm

“…In an analysis of 9 studies including 6,584 patients with moderately severe COPD (Global Initiative for Chronic Obstructive Lung Disease stage IIb), tiotropium decreased the odds of COPD exacerbation (odds ratio [OR], 0.74; 95% CI, 0.66-0.83) and hospitalizations (OR, 0.64; 95% CI, 0.51-0.82) compared with placebo or ipratropium but not with salmeterol. 52 When applied to an average risk of exacerbation of 45% over 1 year, as found in 2 trials of 12 months' duration, the number needed to treat with tiotropium compared with placebo to prevent 1 exacerbation was 14 (95% CI, [11][12][13][14][15][16][17][18][19][20][21][22]. There was no statistically significant difference in all-cause mortality between tiotropium and placebo, ipratropium, or salmeterol in this pooled analysis.…”

Lung-Targeted Overexpression of the NF-κB Member RelB Inhibits Cigarette Smoke–Induced Inflammation

“…Corticosteroids reduce production of the neutrophil chemokine IL-8 in the lungs of both long-term smokers and patients with COPD by as much as 40%, but these compounds have limited effects on neutrophil accumulation in the lungs in these studies. [65][66][67] However, inhaled corticosteroids reduce IL-6 production in the lungs of patients with COPD by 26%, 68 but they do not significantly affect PGE 2 production 69 ; their effects on Cox-2 expression have not yet been established. These findings further underline the limitations of current therapies for inflammatory diseases and highlight the need for newer approaches.…”

Role of Airway Epithelium-Origin Chemokines and their Receptors in COPD~!2009-12-20~!2010-03-18~!2010-04-16~!

“…Clinical study demonstrated that long-term treatment with theophylline could reduce airway inflammation in stable COPD patients by decreasing IL-8 level [45]. The production of IL-8 could be reduced by inhaled steroids in both BALF and PBECs [46,47].…”

“…Other antagonists, e.g. theophylline [45], clarithromycin [48], monoclonal antibody against IL-8 [49,50], could also down-regulate the expression of IL-8 and inhibit neutrophil chemotaxis.…”