In patients with chronic bronchitis a four week trial with inhaled steroids does not attenuate airway inflammation

Systemic corticosteroids have been recommended as a therapeutic option in p atients with moderate to severe COPD. In an early stage of the disease, i.e . chronic bronchitis with mild or no airflow obstruction, a trial with inha led steroids could reveal potential benefits, particularly in terms of a mo dulation of airway inflammation. We therefore investigated the effect of inhaled fluticasone (1000 mug day(- 1)) on markers of airway inflammation in 19 patients with chronic bronchiti s (mean +/- SEM FEV1, 83.4 +/- 3.0% predicted; FEV1/VC, 67.5 +/- 2.4%) in a double-blind, cross-over, placebo-controlled manner. Visits were performed before and after two 4-week treatment periods, separated by a 4-week washo ut period. Lung function, the concentration of exhaled nitric oxide, differ ential cell counts in induced sputum and the number of cells positive for i NOS, as well as the levels of LDH, ECP, neutrophil elastase and IL-8 in spu tum supernatants were determined. Although the total cell number decreased significantly after fluticasone (g eometric mean 12.3 vs. 7.7 x 10(6)/ml; P < 0.05) it was not significantly d ifferent from the change observed after placebo (14.2 vs. 10.6 x 10(6)/ml; n.s.). None of the other parameters showed statistically significant change s after fluticasone or placebo and the results did not depend on the presen ce of airway hyperresponsiveness. We conclude that in patients with chronic bronchitis short-term treatment w ith inhaled corticosterids did not improve lung function or inflammatory pa rameters to an extent which was statistically significant as compared to sp ontaneous variability.