Effects of short-term inhaled fluticasone on oxidative burst of sputum cells in cystic fibrosis patients

Inhaled corticosteroids have been proposed to decrease pulmonary inflammati on in cystic fibrosis (CF). In this study the effects of therapy with inhal ed fluticasone on clinical and sputum outcomes (leukocyte count, activity o f myeloperoxidase, superoxide anion release) in adult CF patients were inve stigated in an open label design. Twenty-six stable patients (median+/-SD forced expiratory volume in one sec ond (FEV1) 58.1+/-19.9% pred.) were randomly assigned to the study group (5 00 mu g b.i.d, for three weeks) or the control group (n=14; nonsteroid medi cation). Sputum samples were obtained during inhalation of hypertonic salin e (3%, 20 min), which was found not to alter the investigated sputum parame ters. No significant changes in clinical parameters, sputum leukocyte count, acti vity of myeloperoxidase, and baseline superoxide anion release where observ ed following therapy. Surprisingly, stimulated superoxide anion release inc reased significantly after therapy (34.1+/-17.7 versus 25.2+/-17.4 nmol.hr( -1).10(6) cells, p<0.03) and exceeded spontaneous variability of this param eter (p=0.02 versus control group). In conclusion, in adult cystic fibrosis patients short-term fluticasone the rapy had no evident effect on clinical and sputum parameters. Further inves tigations are necessary to evaluate whether the observed up-regulation of o xidative capacity of inflammatory cells is of concern or benefit in these p atients.