COPD exacerbations, inflammation and treatment

This thesis describes investigations into the inflammation in COPD, and its treatment. Inflammation in COPD is a central factor in the onset of the disease and its progression. During acute deteriorations of the disease, exacerbations, the inflammation is more severe, and depending on the cause of the exacerbation, it has a different pattern. To date, it has been difficult to efficiently suppress this inflammation, and the anti-inflammatory treatment currently so far has considerable side effects. This thesis describes the results of two clinical trials, in which novel treatment methods to suppress the inflammation in patients with COPD are explored. In the first, we studied the anti-inflammatory effects of budesonide/formoterol inhalation during COPD exacerbations. This treatment method has advantages above the standard treatment with prednisolone tablets since it has fewer side effects. We found that treatment of COPD exacerbations with budesonide/formoterol reduced inflammation compared to placebo and resulted in an improvement in respiratory symptoms. The magnitude of effect was at least as great as that of the prednisolone, but the study was underpowered to formally test the relative strength of these two active treatments. In the second trial, we explored the anti-inflammatory effects of inhaled low dose carbon monoxide. Both cell and animal studies have shown strong anti-inflammatory effects of carbon monoxide. In this trial, 18 patients with COPD were treated with inhalation of a low dose carbon monoxide, which proved its feasibility as a future treatment method. The treatment resulted in trends towards reduction of inflammation and airway hyperresponsiveness, which are to be confirmed in larger studies. The results of both treatment methods are very encouraging, and will be tested in larger future trials