Yildiz F, Kaur A C, Ilgazli A, Celikoglu M, Kaçar Ozkara S, Paksoy N, Ozkarakaş O
Department of Pulmonary Medicine, Kocaeli University School of Medicine, Kocaeli, Turkey.
Respiration. 2000;67(1):71-6. doi: 10.1159/000029466.
Although both inhaled and oral corticosteroids have anti-inflammatory effects causing improvement in clinical symptoms and spirometry in the treatment of asthma, the role of corticosteroids in the management of chronic obstructive pulmonary disease (COPD) is controversial.
To evaluate the effects of inhaled corticosteroids on sputum neutrophilia in clinically stable COPD patients.
In total, 18 patients were enrolled in the study. During 2 months, 9 patients in group A inhaled fluticasone propionate (FP) 500 microg 3 times daily. In group B 9 patients received placebo. All of the patients continued to inhale both salbutamol and ipratropium bromide. In 9 patients, sustained-released theophylline was also administered. Blood samples, spirometric tests, blood gas analyses, and either spontaneous or induced sputum cultures were evaluated on entry into the study, after a 2 months of treatment and following the 6-week washout period.
After the 2-month FP treatment, no significant changes in the number of peripheral blood neutrophils, blood gas and spirometry data were observed in both groups. In group A, the total cell number and the number of neutrophils decreased from a mean of 3. 4 +/- 1.3 x 10(6) cells/g and 0.6 +/- 0.3 x 10(6) neutrophils/g on entry into study to 1.9 +/- 0.6 x 10(6) cells/g and 0.02 +/- 0.01 x 10(6) neutrophils/g after 8-week treatment with FP, returning to 3.3 +/- 1.1 x 10(6) cells/g and 0.5 +/- 0.3 x 10(6) neutrophils/g following the washout period. The percentages of neutrophils were 55. 6 and 77.9% in groups A and B after 2 months of FP treatment. There was no significant change in group B values during the study.
These data suggest that neutrophilic inflammation in sputum may be decreased by inhaled corticosteroids in clinically stable COPD patients.
尽管吸入性和口服糖皮质激素在哮喘治疗中均具有抗炎作用，可改善临床症状和肺功能，但糖皮质激素在慢性阻塞性肺疾病（COPD）管理中的作用仍存在争议。
评估吸入性糖皮质激素对临床稳定的COPD患者痰液中性粒细胞增多的影响。
共纳入18例患者进行研究。在2个月期间，A组9例患者每日吸入3次500微克丙酸氟替卡松（FP）。B组9例患者接受安慰剂治疗。所有患者继续吸入沙丁胺醇和异丙托溴铵。9例患者还给予了缓释茶碱。在研究开始时、治疗2个月后以及6周洗脱期后，对患者进行血样采集、肺功能测试、血气分析以及自发或诱导痰培养评估。
经过2个月的FP治疗后，两组患者外周血中性粒细胞数量、血气和肺功能数据均无显著变化。在A组中，总细胞数和中性粒细胞数从研究开始时的平均3.4±1.3×10⁶细胞/克和0.6±0.3×10⁶中性粒细胞/克，在接受FP治疗8周后降至1.9±0.6×10⁶细胞/克和0.02±0.01×10⁶中性粒细胞/克，洗脱期后又恢复至3.3±1.1×10⁶细胞/克和0.5±0.3×10⁶中性粒细胞/克。FP治疗2个月后，A组和B组中性粒细胞百分比分别为55.6%和77.9%。研究期间B组数值无显著变化。
这些数据表明，吸入性糖皮质激素可能会降低临床稳定的COPD患者痰液中的中性粒细胞炎症。
