EFFECTS OF INHALED AND ORAL GLUCOCORTICOIDS ON INFLAMMATORY INDEXES IN ASTHMA AND COPD

The role of glucocorticoids in the treatment of chronic obstructive pu lmonary disease (COPD) is controversial. We have previously described high numbers of neutrophils and high concentrations of the inflammator y cytokines interleukin-8 (IL-8) and tumor necrosis factor-alpha (TNF- alpha), and of the cell activation markers eosinophil cationic protein (ECP), eosinophil peroxidase (EPO), myeloperoxidase (MPO), and human neutrophil lipocalin (HNL) in COPD patients as compared with controls, and have postulated that the cytokines TNF-alpha and IL-8 play a role in propagating the inflammatory response in COPD. We have now studied the effects of inhaled and oral glucocorticoids on these inflammatory indices in induced sputum. Initially, we studied the effect of a 2-wk course of inhaled budesonide (800 mg twice daily for 2 wk) in 13 pati ents with severe COPD (mean FDV1: 35% predicted). There was no clinica l benefit in either lung function or symptom scores, and no significan t change in the inflammatory indices as measured by total and differen tial cell counts and concentrations of TNF-alpha eosinophil activation markers ECP and EPO, and neutrophil activation markers MPO and HNL. B ecause the lack of anti-inflammatory effect might have been due to poo r drug delivery as a result of severe airflow limitation, we undertook a study examining the antiinflammatory effect of oral prednisolone (3 0 mg daily for 2 wk) in patients with COPD and undertook the same meas urements in 10 patients with atopic asthma. Sputum eosinophil numbers, ECP, and EPO were significantly reduced in the asthmatic patients but were nor modified in COPD. This confirms the clinical impression that inhaled steroids have little antiinflammatory effect, at least in the short term in this group of patients, and suggests that the inflammat ory process in COPD is resistant to the antiinflammatory effect of glu cocorticoids.