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American Journal of Respiratory and Critical Care Medicine Vol 165. pp. 1592-1596, (2002)
© 2002 American Thoracic Society

Original Article

The Effects of Inhaled Fluticasone on Airway Inflammation in Chronic Obstructive Pulmonary Disease

A Double-Blind, Placebo-controlled Biopsy Study

Keith L. Hattotuwa, Mariusz J. Gizycki, Tareq W. Ansari, Peter K. Jeffery and Neil C. Barnes

Lung Pathology Unit, Imperial College School of Medicine at the Royal Brompton Hospital; and London Chest Hospital, London, United Kingdom

Correspondence and requests for reprints should be addressed to Dr. Neil C. Barnes, Department of Thoracic Medicine, London Chest Hospital, Bonner Road, London E2 9JX, UK. E-mail: neil.barnes{at}bartsandthelondon.nhs.uk

Inhaled corticosteroids (ICS) are effective in the treatment of asthma and markedly reduce the numbers of inflammatory cells in bronchial biopsies. However, the effect of ICS on the inflammatory profile of biopsies in smokers with chronic obstructive pulmonary disease (COPD) is unknown. We have performed a double-blind, placebo-controlled, randomized study to compare fluticasone propionate (FP) 500 µg twice daily via a dry powder inhaler and placebo (P) over a 3-month period in subjects with COPD. Fiberoptic bronchoscopy and bronchial biopsy was carried out at baseline and after the 3 months of treatment. Thirty-one subjects completed the trial and 30 paired biopsies were available for analysis. Compared with P (n = 14), subjects on inhaled FP (n = 16) had no significant reductions in the primary endpoints: CD8+, CD68+ cells, or neutrophils, considered to be of importance in COPD. However, there was a reduction in the CD8:CD4 ratio in the epithelium and of the numbers of subepithelial mast cells in the FP group. CD4+ cells were significantly raised in the P group in both subepithelium and epithelium. Symptoms significantly improved, and there were significantly fewer exacerbations in subjects on FP, compared to subjects on P. The data indicate that inhaled fluticasone does affect selected aspects of airway inflammation in COPD, and this may explain, in part, the decrease in exacerbations seen in long-term studies with fluticasone propionate.

Key Words: COPD • fluticasone propionate • inhaled steroid • placebo • randomized • bronchial biopsy • airway inflammation




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