Airway inflammation in COPD after long-term withdrawal of inhaled corticosteroids

[摘要] Long-term treatment with inhaled corticosteroids (ICS) might attenuate lung function decline and decrease airway inflammation in a subset of patients with chronic obstructive pulmonary disease (COPD); and discontinuing ICS treatment could result in further lung function decline. We hypothesised that airway inflammation increases after ICS withdrawal following long-term ICS treatment in COPD.In the GLUCOLD-1 study (GL1); 114 patients with moderate-severe COPD were randomised to 6-month or 30-month treatment with fluticasone propionate (500xe2x80x85xc2xb5g twice daily); 30-month treatment with fluticasone/salmeterol (500/50xe2x80x85xc2xb5g twice daily) or placebo. During the 5-year follow-up study (GL2); patients were followed prospectively while being treated by their physician. Bronchial biopsies and induced sputum were collected at baseline; at 30 months (end of GL1) and at 7.5xe2x80x85years (end of GL2) to assess inflammatory cell counts. Data were analysed using linear mixed-effects models.In patients using ICS during GL1 and using ICS 0xe2x80x9350% of the time during GL2 (n=61/85); there were significant increases in GL2 bronchial CD3+ (fold change per year calculated as GL2 minus GL1 2.68; 95% CI 1.87xe2x80x933.84); CD4+ (1.91; 95% CI 1.33xe2x80x932.75) and CD8+ cells (1.71; 95% CI 1.15xe2x80x932.53); and mast cells (1.91; 95% CI 1.36xe2x80x932.68). The sputum total cell counts increased significantly in GL2 (1.90; 95% CI 1.42xe2x80x932.54); as did counts of macrophages (2.10; 95% CI 1.55xe2x80x932.86); neutrophils (1.92; 95% CI 1.39xe2x80x932.65) and lymphocytes (2.01; 95% CI 1.46xe2x80x932.78).ICS discontinuation increases airway inflammation in patients with moderate-severe COPD; suggesting that the anti-inflammatory effects of ICS in COPD are not maintained after ICS discontinuation.

[学科分类] 呼吸医学