Exhaled nitric oxide and hydrogen peroxide in patients with chronic obstructive pulmonary disease - Effects of inhaled beclomethasone

There is controversy about the role of inhaled corticosteroids in chronic o bstructive pulmonary disease (COPD). Although they appear to have little im pact on airways obstruction or its progression, their use may reduce the fr equency and/or severity of exacerbations in a subset of patients. We undert ook the following study to determine the impact of inhaled corticosteroid o n two noninvasive markers of airways inflammation. We assigned 20 stable no nsmoking patients with COPD in random, double-blind crossover fashion to tw o 2-wk treatment periods with inhaled beclomethasone SOO mug twice daily or matching placebo, followed by a 2-wk washout period. We measured exhaled n itric oxide (ENO), breath condensate H2O2, and flow volume spirometry at we ekly intervals. Median baseline ENO was 26.2 (19.3 to 54.8) ppb and fell si gnificantly following 1 and 2 wk of beclomethasone (-10.6 ppb, p = 0.002, a nd -6.3 ppb, p = 0.013, respectively) but was unchanged by placebo inhalati on. Breath condensate H2O2 levels did not change significantly with inhaled beclomethasone or placebo. Although there were no significant changes in F EV1 with BDP therapy, there was a moderate inverse correlation between chan ges in ENO and changes in FEV1 (r -0.50). We conclude that inhaled beclomet hasone reduces ENO levels in stable nonsmoking patients with COPD, a findin g compatible with an antiinflammatory mechanism of action.