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Bronchodilator reversibility, airway eosinophilia and anti-inflammatory effects of inhaled fluticasone in COPD are not related

Citation

Reid, DW and Wen, Y and Johns, DP and Williams, TJ and Ward, C and Walters, EH, Bronchodilator reversibility, airway eosinophilia and anti-inflammatory effects of inhaled fluticasone in COPD are not related, Respirology, 13, (6) pp. 799-809. ISSN 1323-7799 (2008) [Refereed Article]

DOI: doi:10.1111/j.1440-1843.2008.01380.x

Abstract

Background and objective: Bronchodilator reversibility (BDR) is common in smoking-related COPD, but the airway pathology underlying this has not been described. In particular, it is not known whether BDR is associated with underlying airway eosinophilia and whether BDR is predictive of a better response to inhaled corticosteroid (ICS) treatment. Methods: A double-blind, placebo-controlled, randomized 2 : 1 study of fluticasone propionate (FP), 500 μg twice daily versus placebo over 6 months was performed in subjects with mild to moderate COPD. Subjects with a clinical history of asthma were excluded, but not on BDR criteria alone. Induced sputum, BAL and endobronchial biopsies (EBB) were performed in 36 subjects at baseline, and 30 of these provided a second full set of samples (FP, n = 19; placebo, n = 11). Results: Baseline BDR was not related to airway eosinophilia and did not predict response to ICS. Post-bronchodilator FEV 1 increased in the FP group compared with the placebo group (P = 0.05), and there were within-treatment group reductions in total symptom scores with FP (P < 0.05). Compared with placebo, FP reduced macrophage numbers but increased neutrophil numbers in EBB (P = 0.01 and P = 0.003, respectively). BAL neutrophil and epithelial cell numbers were also reduced with FP (P = 0.03 for both). There were within-treatment group reductions in the numbers of EBB mast cells and CD8+ve lymphocytes with FP (P = 0.007). Conclusions: BDR was not related to any particular inflammatory phenotype or any clinical or anti-inflammatory response to ICS in these subjects with mild to moderate COPD. © 2008 The Authors.

Item Details

Item Type:Refereed Article
Research Division:Medical and Health Sciences
Research Group:Cardiorespiratory Medicine and Haematology
Research Field:Respiratory Diseases
Objective Division:Health
Objective Group:Clinical Health (Organs, Diseases and Abnormal Conditions)
Objective Field:Respiratory System and Diseases (incl. Asthma)
Author:Reid, DW (Dr David Reid)
Author:Wen, Y (Dr Yudong Wen)
Author:Johns, DP (Associate Professor David Johns)
Author:Ward, C (Dr Christopher Ward)
Author:Walters, EH (Professor Haydn Walters)
ID Code:53897
Year Published:2008
Web of Science® Times Cited:23
Deposited By:Menzies Institute for Medical Research
Deposited On:2009-01-20
Last Modified:2009-05-02
Downloads:0

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