Inhaled corticosteroids may reduce neutrophilic inflammation in patients with stable chronic obstructive pulmonary disease

Background: Although both inhaled and oral corticosteroids have anti-inflam matory effects causing improvement in clinical symptoms and spirometry in t he treatment of asthma, the role of corticosteroids in the management of ch ronic obstructive pulmonary disease (COPD) is controversial. Objective: To evaluate the effects of inhaled corticosteroids on sputum neutrophilia in c linically stable COPD patients. Methods: In total, 18 patients were enrolle d in the study. During 2 months, 9 patients in group A inhaled fluticasone propionate (FP) 500 mu g 3 times daily. In group B 9 patients received plac ebo. All of the patients continued to inhale both salbutamol and ipratropiu m bromide. In 9 patients, sustained-released theophylline was also administ ered. Blood samples, spirometric tests, blood gas analyses, and either spon taneous or induced sputum cultures were evaluated on entry into the study, after a 2 months of treatment and following the 6-week washout period. Resu lts: After the 2-month FP treatment, no significant changes in the number o f peripheral blood neutrophils, blood gas and spirometry data were observed in both groups. In group A, the total cell number and the number of neutro phils decreased from a mean of 3.4 +/- 1.3 x 10(6) cells/g and 0.6 +/- 0.3 x 10(6) neutrophils/g on entry into study to 1.9 +/- 0.6 x 10(6) cells/g an d 0.02 +/- 0.01 x 10(6) neutrophils/g after 8-week treatment with FP, retur ning to 3.3 +/- 1.1 x 10(6) cells/g and 0.5 +/- 0.3 x 10(6) neutrophils/g f ollowing the washout period. The percentages of neutrophils were 55.6 and 7 7.9% in groups A and B after 2 months of FP treatment. There was no signifi cant change in group B values during the study. Conclusion: These data sugg est that neutrophilic inflammation in sputum may be decreased by inhaled co rticosteroids in clinically stable COPD patients. Copyright (C) 2000 S. Kar ger AG, Basel.