EFFECT OF FLUTICASONE PROPIONATE ON SPUTUM OF PATIENTS WITH CHRONIC-BRONCHITIS AND EMPHYSEMA

The effects of fluticasone propionate (FP) on sputum chemotactic activ ity, elastase inhibitory potential, albumin concentrations, and periph eral neutrophil function were studied in a group of patients with clin ically stable, smoking-related chronic bronchitis and emphysema. Seven teen patients (50 to 75 yr of age) were entered into a double-blind, p lacebo-controlled study of 1.5 mg inhaled FP/d for 8 wk. Following tre atment with FP the chemotactic activity of the sputum sol phase was lo wer than the corresponding values for the placebo group (p < 0.01). Va lues fell from a mean of 21.75 (+/- 1.58) during the run-in period to 18.37 (+/- 1.46; p < 0.01) after 4 wk and 17.63 (+/- 1.86; p < 0.05) a fter 8 wk treatment returning to 22.08 (+/- 1.26) cell/field after the washout period. The neutrophil elastase inhibitory capacity of the sp utum sol phase increased (p < 0.025) with treatment from a mean of 0.1 77 mu M elastase inhibited/L (+/- 0.05) pretreatment to 0.413 mu M (+/ - 0.054) after 4 wk and 0.415 mu M (+/- 0.054) after 8 wk returning to 0.270 mu M (+/- 0.07) after the washout period. Treatment with FP did not result in a change in the peripheral neutrophil functions studied or sputum albumin and myeloperoxidase concentrations. The results sug gest that FP may play a protective role in these patients through a re duction in the chemotactic activity of lung secretions and potentially a reduction in the recruitment of neutrophils to the lung, and also b y directly affecting the proteinase/antiproteinase balance, in favor o f antiproteinases, within lung secretions.