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Published ahead of print on June 30, 2004, doi:10.1164/rccm.200404-543OC

Am. J. Respir. Crit. Care Med., Volume 170, Number 7, October 2004, 760-765

A more recent version of this article appeared on October 1, 2004
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Submitted on April 27, 2004
Accepted on June 29, 2004

Effects of Fluticasone on Systemic Markers of Inflammation in Chronic Obstructive Pulmonary Disease

Don D Sin1, Paige Lacy2, Ernest York3, and S. F. Paul Man1*

1 University of British Columbia, The James Hogg iCAPTURE Center for Cardiovascular and Pulmonary Research, Vancouver, BC, Canada; Department of Medicine, Pulmonary Division, University of British Columbia, Vancouver, BC, Canada, 2 Department of Medicine, Pulmonary Division, University of Alberta, Edmonton, AB, Canada, 3 Department of Medicine, Pulmonary Division, University of Alberta, Edmonton, AB, Canada; Wetaskiwin General Hospital, Wetaskiwin, AB, Canada

* To whom correspondence should be addressed. E-mail: PMan{at}providencehealth.bc.ca.

Systemic inflammation is present in chronic obstructive pulmonary disease (COPD), which has been linked to cardiovascular morbidity and mortality. We determined the effects of oral and inhaled corticosteroids on serum markers of inflammation in patients with stable COPD. We recruited 41 patients with mild to moderate COPD. After 4 weeks during which inhaled corticosteroids were discontinued, patients were assigned to fluticasone (500 mcg b.i.d.), oral prednisone (30 mg/d) or placebo over 2 weeks, followed by 8 weeks of fluticasone at 500 mcg b.i.d. and another 8 weeks at 1000 mcg b.i.d. Withdrawal of inhaled corticosteroids increased baseline C-reactive protein (CRP) levels by 71% (95% confidence interval, CI, 16% to 152%). Two weeks with inhaled fluticasone reduced CRP levels by 50% (95% CI, 9% to 73%); prednisone reduced it by 63% (95% CI, 29 to 81%). No significant changes were observed with the placebo. Additional 8 weeks of fluticasone was associated with CRP levels that were lower than those at baseline (29% reduction; 95% CI, 7% to 46%). Inhaled and oral corticosteroids are effective in reducing serum CRP levels in patients with COPD and suggest their potential use for improving cardiovascular outcomes in COPD.
Key words: corticosteroid, fluticasone, prednisone, COPD, C-reactive protein




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