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Inhaled Fluticasone and Salmeterol Suppress Eosinophilic Airway Inflammation in Chronic Obstructive Pulmonary Disease: Relations with Lung Function and Bronchodilator Reversibility

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Abstract

The aim of this study was to determine whether combined inhaled corticosteroids and long-acting β2 agonists can suppress eosinophilic inflammation in chronic dostructive plumonary disease (COPD) and to investigate the association between the level of eosinophilia and the degree of bronchodilator reversibility. Sixty-two patients with stable COPD (forced expiratory volume in 1 [FEV1] of 30%–70% predicted before bronchodilation) were enrolled from our outpatient clinic. Patients received inhaled fluticasone (100 µg)/salmeterol (50 µg) twice daily for two months. Lung function measurements, bronchodilator tests, and sputum induction were performed. The number of inflammatory cells and mediators, including interleukin-8 (IL-8), tumor necrosis factor-α (TNF-α), and eosinophilic cationic protein (ECP), were measured. Treatment with inhaled fluticasone and salmeterol significantly suppressed eosinophilic inflammation in COPD patients with sputum eosinophilia (mean 8.9% ± 2.0% vs. 1.6% ± 0.5%, p = 0.003), but insignificant differences in FEV1 and FVC between patients with and without eosinophilia suggested that suppression of eosinophilic inflammation had no effect on FEV1 or FVC. Reduction in the percentage of eosinophils was significantly correlated with decreased levels of ECP (r = 0.48, p < 0.001). Levels of neutrophils, IL-8, and TNF-α were not affected. Sputum eosinophilia was not related to the degree of bronchodilator reversibility. The degree of bronchodilator reversibility did not predict the increase in FEV1 and FVC after treatment with inhaled corticosteroids/long-acting β2 agonists. Suppression of eosinophilic inflammation and bronchodilator responsiveness indices were not correlated with clinical outcomes in COPD patients treated with inhaled corticosteroids/long-acting β2 agonists.

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References

  1. American Thoracic Society (1987) Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease (COPD) and asthma. Am Rev Respir Dis 136:225–244

    Google Scholar 

  2. Anthonisen NR, Wright EC, Hodgkin JE (1986) Prognosis in chronic obstructive pulmonary disease. Am Rev Respir Dis 133:14–20

    PubMed  CAS  Google Scholar 

  3. Barr JT, Schumacher GE, Freeman S, et al. (2000) American translation, modification, and validation of the St. George’s Respiratory Questionnaire. Clin Ther 22:1121–1145

    Article  PubMed  CAS  Google Scholar 

  4. Brightling CE, Monteiro W, Ward R, et al. (2000) Sputum eosinophilia and short-term response to prednisolone in chronic obstructive pulmonary disease: a randomised controlled trial. Lancet 356:1480–1485

    Article  PubMed  CAS  Google Scholar 

  5. Burge PS, Calverley PM, Jones PW, et al. (2000) Randomised, double blind, placebo controlled study of fluticasone propionate in patients with moderate to severe chronic obstructive pulmonary disease: the ISOLDE trial. BMJ 320:1297–1303

    Article  PubMed  CAS  Google Scholar 

  6. Calverley PM, Burge PS, Spencer S, Anderson JA, Jones PW (2003) Bronchodilator reversibility testing in chronic obstructive pulmonary disease. Thorax 58:659–664

    Article  PubMed  CAS  Google Scholar 

  7. Culpitt SV, Maziak W, Loukidis S, et al. (1999) Effect of high dose inhaled steroid on cells, cytokines, and proteases in induced sputum in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 160:1635–1639

    PubMed  CAS  Google Scholar 

  8. Dales RE, Spitzer WO, Tousignant P, Schechter M, Suissa S (1988) Clinical interpretation of airway response to a bronchodilator. Epidemiologic considerations. Am Rev Respir Dis 138:317–320

    PubMed  CAS  Google Scholar 

  9. Djukanovic R, Wilson JW, Britten KM, et al. (1992) Effect of an inhaled corticosteroid on airway inflammation and symptoms in asthma. Am Rev Respir Dis 145:669–674

    PubMed  CAS  Google Scholar 

  10. Fujimoto K, Kubo K, Yamamoto H, Yamaguchi S, Matsuzawa Y (1999) Eosinophilic inflammation in the airway is related to glucocorticoid reversibility in patients with pulmonary emphysema. Chest 115:697–702

    Article  PubMed  CAS  Google Scholar 

  11. Gizycki MJ, Hattotuwa KL, Barnes N, Jeffery PK (2002) Effects of fluticasone propionate on inflammatory cells in COPD: an ultrastructural examination of endobronchial biopsy tissue. Thorax 57:799–803

    Article  PubMed  CAS  Google Scholar 

  12. Hattotuwa KL, Gizycki MJ, Ansari TW, Jeffery PK, Barnes NC (2002) The effects of inhaled fluticasone on airway inflammation in chronic obstructive pulmonary disease: a double-blind, placebo-controlled biopsy study. Am J Respir Crit Care Med 165:1592–1596

    Article  PubMed  Google Scholar 

  13. Keatings VM, Jatakanon A, Worsdell YM, Barnes PJ (1997) Effects of inhaled and oral glucocorticoids on inflammatory indices in asthma and COPD. Am J Respir Crit Care Med 155:542–548

    PubMed  CAS  Google Scholar 

  14. Kerstjens HA, Brand PL, Hughes MD, et al. (1992) A comparison of bronchodilator therapy with or without inhaled corticosteroid therapy for obstructive airways disease. Dutch Chronic Non-Specific Lung Disease Study Group. N Engl J Med 327:1413–1419

    Article  PubMed  CAS  Google Scholar 

  15. Lung Health Study Research Group, (2000) Effect of inhaled triamcinolone on the decline in pulmonary function in chronic obstructive pulmonary disease. N Engl J Med 343:1902–1909

    Article  Google Scholar 

  16. National Institutes of Health (2003) National Heart Lung, and Blood Institute. Global Initiative for Chronic Obstructive Lung Disease: Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. NHLBI/WHO workshop report. Updated July 2003

    Google Scholar 

  17. Papi A, Romagnoli M, Baraldo S, et al. (2000) Partial reversibility of airflow limitation and increased exhaled NO and sputum eosinophilia in chronic obstructive pulmonary disease. Am J Respir Grit Care Med 162:1773–1777

    CAS  Google Scholar 

  18. Pauwels RA, Lofdahl CG, Laitinen LA, et al. (1999) Long-term treatment with inhaled budesonide in persons with mild chronic obstructive pulmonary disease who continue smoking. European Respiratory Society Study on Chronic Obstructive Pulmonary Disease. N Engl J Med 340:1948–1953

    Article  PubMed  CAS  Google Scholar 

  19. Perng DW, Huang HY, Lee YC, Perng RP (2004) Leukotriene modifier vs inhaled corticosteroid in mild-to-moderate asthma: clinical and anti-inflammatory effects. Chest 125:1693–1699

    Article  PubMed  CAS  Google Scholar 

  20. Perng DW, Huang HY, Chen HM, Lee YC, Perng RP (2004) Characteristics of airway inflammation and bronchodilator reversibility in COPD: a potential guide to treatment. Chest 126:375–381

    Article  PubMed  Google Scholar 

  21. Pin I, Radford S, Kolendowicz R, et al. (1993) Airway inflammation in symptomatic and asymptomatic children with methacholine hyperresponsiveness. Eur Respir J 6:1249–1256

    PubMed  CAS  Google Scholar 

  22. Pizzichini E, Pizzichini M, Gibson P, et al. (1998) Sputum eosinophilia predicts benefit from prednisone in smokers with chronic obstructive bronchitis. Am J Respir Crit Care Med 158:1511–1517

    PubMed  CAS  Google Scholar 

  23. Sutherland ER, Allmers H, Ayas NT, Venn AJ, Martin RJ (2003) Inhaled corticosteroids reduce the progression of airflow limitation in chronic obstructive pulmonary disease: a meta-analysis. Thorax 58:937–941

    Article  PubMed  CAS  Google Scholar 

  24. Szafranski W, Cukier A, Ramirez A, et al. (2003) Efficacy and safety of budesonide/formoterol in the management of chronic obstructive pulmonary disease. Eur Respir J 21:74–81

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

This work was funded by a research grant (VGH94-305) from the Taipei Veterans General Hospital, Taiwan.

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Authors and Affiliations

  1. Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan

    Diahn-Warng Perng, Cheng-Che Wu, Kang-Cheng Su, Yu-Chin Lee & Reury-Perng Perng

  2. School of Medicine, National Yang-Ming University, Taipei, Taiwan

    Diahn-Warng Perng, Cheng-Che Wu, Yu-Chin Lee, Reury-Perng Perng & Chi-Wei Tao

  3. Cheng Hsin Rehabilitation Center, Taipei, Taiwan

    Chi-Wei Tao

  4. Department of Chest Medicine, Taipei Veterans General Hospital, 201, Section 2, Shih-Pai Road, Taipei, 11217, Taiwan

    Diahn-Warng Perng & Chi-Wei Tao

Authors
  1. Diahn-Warng Perng
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  2. Cheng-Che Wu
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  3. Kang-Cheng Su
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  4. Yu-Chin Lee
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  5. Reury-Perng Perng
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  6. Chi-Wei Tao
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Correspondence to Diahn-Warng Perng.

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Diahn-Warng Perng and Cheng-Che Wu contributed equally to this work.

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Perng, DW., Wu, CC., Su, KC. et al. Inhaled Fluticasone and Salmeterol Suppress Eosinophilic Airway Inflammation in Chronic Obstructive Pulmonary Disease: Relations with Lung Function and Bronchodilator Reversibility. Lung 184, 217–222 (2006). https://doi.org/10.1007/s00408-005-2586-8

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  • DOI: https://doi.org/10.1007/s00408-005-2586-8

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