INHALED CORTICOSTEROIDS REDUCE NEUTROPHILIC BRONCHIAL INFLAMMATION INPATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY-DISEASE

Background-Airways inflammation is a feature of chronic obstructive pu lmonary disease (COPD), but the role of corticosteroids in the managem ent of clinically stable patients has yet to be established. A randomi sed controlled study was carried out to investigate the effect of high dose inhaled beclomethasone dipropionate (BDP) administered for two m onths to patients with stable, smoking related COPD. Sputum induction was used to evaluate bronchial inflammation response. Methods-34 patie nts (20 men and 14 women) were examined on three separate occasions. A t the initial clinical assessment (visit 0), spirometry and blood gas analysis were performed. On visit 1 (within one week of visit 0) sputu m induction was performed and each patient was randomised to receive e ither BDP 500 mu g three times daily (treated group) or nothing (contr ol group). After two months (visit 2), all patients underwent repeat c linical assessment, spirometry, and sputum induction. Results-There we re no differences in sputum cell counts between the groups at baseline . After two months of treatment, induced sputum samples from patients in the treated group showed a reduction in both neutrophils (-27%) and total cells (-42%) with respect to baseline, while the control group did not (neutrophils +9%, total cells +7%). Macrophages increased in t he treated group but not in the control group. The mean final value of sputum neutrophils was 52% in the treated group and 73.3% in the cont rol group (95% confidence interval (CI) -27.2 to -15.4). The mean fina l value of sputum macrophages was 35.8% in treated group and 19.3% in control group (95% CI 10.3 to 22.8). The differences between the treat ed and control groups for neutrophils (-21.3%), macrophages (+16.5%), and total cells (-65%) were significant. Spirometry and blood gas data did not change from baseline in either patient group. Conclusions-A t wo month course of treatment with high dose inhaled BDP reduces signif icantly neutrophil cell counts in patients with clinically stable, smo king related COPD. Further studies on the effectiveness of inhaled ste roids in COPD are needed to confirm the clinical importance of this ob servation.