RT Journal Article
SR Electronic
T1 Effects of fluticasone propionate in COPD patients with bronchial hyperresponsiveness
JF Thorax
JO Thorax
FD BMJ Publishing Group Ltd and British Thoracic Society
SP 694
OP 700
DO 10.1136/thorax.57.8.694
VO 57
IS 8
A1 G T Verhoeven
A1 J P J J Hegmans
A1 P G H Mulder
A1 J M Bogaard
A1 H C Hoogsteden
A1 J-B Prins
YR 2002
UL http://thorax.bmj.com/content/57/8/694.abstract
AB Background: Treatment of chronic obstructive pulmonary disease (COPD) with inhaled corticosteroids does not appear to be as effective as similar treatment of asthma. It seems that only certain subgroups of patients with COPD benefit from steroid treatment. A study was undertaken to examine whether inhaled fluticasone propionate (FP) had an effect on lung function and on indices of inflammation in a subgroup of COPD patients with bronchial hyperresponsiveness (BHR). Methods: Twenty three patients with COPD were studied. Patients had to be persistent current smokers between 40 and 70 years of age. Non-specific BHR was defined as a PC20 for histamine of ≤8 mg/ml. Patients received either 2 × 500 μg FP or placebo for 6 months. Expiratory volumes were measured at monthly visits, BHR was determined at the start of the study and after 3 and 6 months, and bronchial biopsy specimens were taken at the start and after 6 months of treatment. Biopsy specimens from asymptomatic smokers served as controls. Results: In contrast to asthma, indices of BHR were not significantly influenced by treatment with FP. Forced expiratory volume in 1 second (FEV1) showed a steep decline in the placebo group but remained stable in patients treated with FP. FEV1/FVC, and maximal expiratory flows at 50% and 25% FVC (MEF50, MEF25) were significantly increased in the FP treated patients compared with the placebo group. Biopsy specimens were analysed for the presence of CD3+, CD4+, CD8+, MBP+, CD15+, CD68+, CD1a, and tryptase cells. FP treatment resulted in marginal reductions in these indices of inflammation. Conclusion: In patients with COPD and BHR, FP has a positive effect on indices of lung function compared with placebo. Bronchial inflammation analysed in bronchial biopsy specimens is only marginally reduced.