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

AbstractSystemic corticosteroids have been recommended as a therapeutic option in patients 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 inhaled steroids could reveal potential benefits, particularly in terms of a modulation of airway inflammation.We therefore investigated the effect of inhaled fluticasone (1000 μ g day−1) on markers of airway inflammation in 19 patients with chronic bronchitis (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 washout period. Lung function, the concentration of exhaled nitric oxide, differential cell counts in induced sputum and the number of cells positive for iNOS, as well as the levels of LDH, ECP, neutrophil elastase and IL-8 in sputum supernatants were determined.Although the total cell number decreased significantly after fluticasone (geometric mean 12·3 vs. 7·7×106/ml;P