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a Divisione di
Pneumologia, Ospedale Maggiore di Crema, Italy, b Divisione di Pneumologia, Ospedale di Lodi,
Italy, c Divisione di
Pneumologia, Fondazione "S Maugeri", Tradate, Italy
Correspondence to: Dr M Confalonieri, via Crotti, 24, I-29100 Piacenza, Italy.
Received 12 September 1997; Returned to authors 5 January 1998; Revised version received 31 March 1998; Accepted for publication 31 March 1998
BACKGROUND
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.
METHODS34 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 µg three times daily (treated group) or nothing
(control group). After two months (visit 2), all patients underwent
repeat clinical assessment, spirometry, and sputum induction.
RESULTSThere 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.
CONCLUSIONSA 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.
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