Background: 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. Objective: To evaluate the effects of inhaled corticosteroids on sputum neutrophilia in clinically stable COPD patients. Methods: In total, 18 patients were enrolled in the study. During 2 months, 9 patients in group A inhaled fluticasone propionate (FP) 500 μg 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. Results: 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 × 106 cells/g and 0.6 ± 0.3 × 106 neutrophils/g on entry into study to 1.9 ± 0.6 × 106 cells/g and 0.02 ± 0.01 × 106 neutrophils/g after 8-week treatment with FP, returning to 3.3 ± 1.1 × 106 cells/g and 0.5 ± 0.3 × 106 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. Conclusion: These data suggest that neutrophilic inflammation in sputum may be decreased by inhaled corticosteroids in clinically stable COPD patients.

Fletcher C, Peto R, Tinker C, Speizer FE: The Natural History of Chronic Bronchitis and Emphysema. An Eight Year Study of Early Chronic Obstructive Lung Disease in Working Men in London. Oxford, Oxford University Press, 1976.
Thompson AB, Daugton GA, Robbins GA, Ghafouri MA, Oehlerking M, Rennard SA: Intraluminal airway inflammation in chronic bronchitis. Characterization and correlation with clinic parametres. Am Rev Respir Dis 1989;140:1527–1537.
Saetta M, Di Stefano A, Maestrelli P, Turato G, Ruggieri MP, Roggeri A, Calcagni P, Map CE, Ciaccia A, Fabbri LM: Airway eosinophilia in chronic bronchitis during exacerbations. Am J Respir Crit Care Med 1994;150:1646–1652.
Gibson PG, Girgis-Gabardo A, Morris MM, Mattoli S, Kay JM, Dolovich J, Denburg J, Hargreave FE: Cellular characteristics of sputum from patients with asthma and chronic bronchitis. Thorax 1989;44:693–699.
Ollerenshaw SL, Woolcock AJ: Characteristics of the inflammation in biopsies from large airways of asthma and subjects with chronic airflow limitation. Am Rev Respir Dis 1992;145:922–927.
Barnes PJ, Pedersen S: Efficacy and safety of inhaled corticosteroids in asthma. Report of workshop held in Eze, France, October 1992. Am Rev Respir Dis 1993;152:S77–S124.
American Thoracic Society Statement: Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1995;152:S77–S124.
Siafakas NM, Vermeire P, Pride NB, Poaletti P, Gibson J, Howard P, Yernault JC, Decramer M, Higgenbottam T, Postma DS, Rees J: Optimal assessment and management of chronic obstructive pulmonary disease. Eur Respir J 1995;8:1398–1420.
Pauwels RA, Lofdahl CG, Pride NB, Postma DS, Laitinen LA, Ohlsson SV: European Respiratory Society study on COPD (EUROSCOP): Hypothesis and design. Eur Respir J 1992;5:1254–1261.
Lomas DA, Chamba A, Ip M, Stockley RA: The effect of dexamethasone on human neutrophil function in vitro and in vivo. Agents Actions 1991;33:279–285.
Keatings VM, Collins PD, Scott DM, Barnes PJ: Differences in interleukin-8 and tumor necrosis factor-α in induced sputum from patients with chronic obstructive pulmonary disease and asthma. Am J Respir Crit Care Med 1996;153:530–534.
Holgate ST: Similarities and discrepancies between asthma and obstructive pulmonary disease. Cellular mechanisms. Reflection by the chairman. Am Rev Respir Dis 1991;143:1175–1176.
Keatings VM, Jatakanon A, Worsdell YM, Barnes PJ: Effects of inhaled and oral glucocorticoids on inflammatory indices in asthma and COPD. Am J Respir Crit Care Med 1997;155:542–548.
Wier DC, Burge PS: Effects of high dose inhaled beclomethasone dipropionate, 750 μg and 1500 μg twice daily, and 40 mg per day oral prednisolone on lung function symptoms, and bronchial hyperresponsiveness in patients with non-asthmatic airflow obstruction. Thorax 1993;48:309–316.
Postma DS, Steenhuis EJ, Van der Weele LT, Sluiter HJ: Severe chronic airflow obstruction: Can corticosteroids slow down progression? Eur J Respir Dis 1985;67:56–64.
Postma DS, Peters I, Steenhuis EJ, Sluiter HJ: Moderately severe chronic airflow obstruction: Can corticosteroids slow down obstruction? Eur Respir J 1988;1:22–26.
Totti N, McCusker KT, Campbell EJ, Senio RM: Nicotine is chemotactic for neutrophils and enhances neutrophil responsiveness to chemotactic peptides. Science 1984;223:169–171.
Shoji S, Ertl R, Rennard SI: Cigarette smoke stimulates release of neutrophil chemotactic activity from cultured bronchial epithelial cells (abstract). Clin Res 1987;35:39a.
Hunninghake GW, Crystal RG: Cigarette smoking and lung destruction. Am Rev Respir Dis 1983;128:833–838.
Weir D, Jones S, Chamba A, Sherwood-Burge P, Stockely RA: The effect of inhaled beclomethasone dipropionate on peripheral neutrophil function in patients with chronic airflow obstruction. Thorax 1990;45:323.
Llewellyn-Jones CG, Harris TAS, Stockley RA: Effect of fluticasone propionate on sputum of patients with chronic bronchitis and emphysema. Am J Respir Crit Care Med 1996;153:616–621.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.