Confalonieri M, Mainardi E, Della Porta R, Bernorio S, Gandola L, Beghè B, Spanevello A
Divisione di Pneumologia, Ospedale Maggiore di Crema, Italy.
Thorax. 1998 Jul;53(7):583-5. doi: 10.1136/thx.53.7.583.
Airways inflammation is a feature of chronic obstructive pulmonary disease (COPD), but the role of corticosteroids in the management of clinically stable patients has yet to be established. A randomised controlled study was carried out to investigate the effect of high dose inhaled beclomethasone dipropionate (BDP) administered for two months to patients with stable, smoking related COPD. Sputum induction was used to evaluate bronchial inflammation response.
34 patients (20 men and 14 women) were examined on three separate occasions. At the initial clinical assessment (visit 0), spirometry and blood gas analysis were performed. On visit 1 (within one week of visit 0) sputum induction was performed and each patient was randomised to receive either BDP 500 micrograms three times daily (treated group) or nothing (control group). After two months (visit 2), all patients underwent repeat clinical assessment, spirometry, and sputum induction.
There were no differences in sputum cell counts between the groups at baseline. After two months of treatment, induced sputum samples from patients in the treated group showed a reduction in both neutrophils (-27%) and total cells (-42%) with respect to baseline, while the control group did not (neutrophils +9%, total cells +7%). Macrophages increased in the treated group but not in the control group. The mean final value of sputum neutrophils was 52% in the treated group and 73.3% in the control group (95% confidence interval (CI) -27.2 to -15.4). The mean final value of sputum macrophages was 35.8% in treated group and 19.3% in control group (95% CI 10.3 to 22.8). The differences between the treated and control groups for neutrophils (-21.3%), macrophages (+16.5%), and total cells (-65%) were significant. Spirometry and blood gas data did not change from baseline in either patient group.
A two month course of treatment with high dose inhaled BDP reduces significantly neutrophil cell counts in patients with clinically stable, smoking related COPD. Further studies on the effectiveness of inhaled steroids in COPD are needed to confirm the clinical importance of this observation.
气道炎症是慢性阻塞性肺疾病（COPD）的一个特征，但皮质类固醇在临床稳定患者管理中的作用尚未明确。开展了一项随机对照研究，以调查高剂量吸入丙酸倍氯米松（BDP）对稳定期、与吸烟相关的COPD患者进行为期两个月治疗的效果。采用痰液诱导法评估支气管炎症反应。
34例患者（20例男性和14例女性）在三个不同时间点接受检查。在初始临床评估（访视0）时，进行肺功能测定和血气分析。在访视1（访视0后一周内）进行痰液诱导，每位患者被随机分配接受每日三次500微克BDP（治疗组）或不接受任何治疗（对照组）。两个月后（访视2），所有患者均接受重复临床评估、肺功能测定和痰液诱导。
两组在基线时痰液细胞计数无差异。经过两个月的治疗，治疗组患者的诱导痰液样本显示中性粒细胞（-27%）和总细胞（-42%）相对于基线均减少，而对照组未出现这种情况（中性粒细胞+9%，总细胞+7%）。治疗组巨噬细胞增加，而对照组未增加。治疗组痰液中性粒细胞的最终均值为52%，对照组为73.3%（95%置信区间（CI）-27.2至-15.4）。治疗组痰液巨噬细胞的最终均值为35.8%，对照组为19.3%（95%CI 10.3至22.8）。治疗组与对照组在中性粒细胞（-21.3%）、巨噬细胞（+16.5%）和总细胞（-65%）方面的差异具有统计学意义。两组患者的肺功能测定和血气数据与基线相比均未改变。
高剂量吸入BDP进行为期两个月的治疗可显著降低临床稳定、与吸烟相关的COPD患者的中性粒细胞计数。需要对吸入性类固醇在COPD中的有效性进行进一步研究，以证实这一观察结果的临床重要性。
