Inhaled fluticasone reduces sputum inflammatory indices in severe bronchiectasis

• Published in: American journal of respiratory and critical care medicine Vol. 158; no. 3; pp. 723 - 727
• Main Authors: TSANG, K. W. T, HO, P.-L, LAM, W.-K, IP, M. S. M, CHAN, K.-N, HO, C.-S, OOI, C. C. G, YUEN, K. Y
• Format: Journal Article
• Language: English
• Published: New York, NY American Lung Association 01.09.1998
• Subjects: Administration, Inhalation; Administration, Topical; Adult; Androstadienes - administration & dosage; Androstadienes - therapeutic use; Anti-Inflammatory Agents - administration & dosage; Anti-Inflammatory Agents - therapeutic use; Biological and medical sciences; Bronchiectasis - drug therapy; Bronchiectasis - immunology; Bronchiectasis - microbiology; Bronchiectasis - pathology; Double-Blind Method; Female; Fluticasone; Forced Expiratory Volume - drug effects; Glucocorticoids; Humans; Inflammation; Interleukin-1 - analysis; Interleukin-8 - analysis; Leukocyte Count - drug effects; Leukotriene B4 - analysis; Male; Medical sciences; Middle Aged; Nebulizers and Vaporizers; Peak Expiratory Flow Rate - drug effects; Pharmacology. Drug treatments; Placebos; Pseudomonas aeruginosa - isolation & purification; Respiratory system; Sputum - cytology; Sputum - drug effects; Sputum - immunology; Sputum - microbiology; Tumor Necrosis Factor-alpha - analysis; Vital Capacity - drug effects; Human; Corticosteroid; Respiratory disease; Treatment efficiency; Antiinflammatory agent; Cytokine; Biological marker; Exploration; Bronchiectasis; Inflammation; Fluticasone; Inhalation; Chemotherapy; Treatment; Sputum; Bronchus disease; High dose
• ISSN: 1073-449X; 1535-4970
• DOI: 10.1164/ajrccm.158.3.9710090

Although corticosteroid therapy might be clinically beneficial for bronchiectasis, very little is known of its effects on the inflammatory and infective markers in bronchiectasis. We have therefore performed a double-blind, placebo-controlled study to evaluate the effects of a 4-wk administration of inhaled fluticasone in bronchiectasis. Twenty-four patients (12 female; mean age 51 yr) were randomized into receiving either inhaled fluticasone (500 microgram twice daily) via the Accuhaler device (n = 12) or placebo. At each visit, spirometry, 24-h sputum volume, sputum leukocyte density, bacterial densities, and concentrations of interleukin (IL)-1beta, IL-8, tumor necrosis factor-alpha (TNF-alpha), and leukotriene B4 (LTB4) were determined. There was a significant (p < 0.05) decrease in sputum leukocyte density and IL-1beta, IL-8, and LTB4 after fluticasone treatment. The fluticasone group had one and the placebo group three episodes of exacerbation. There were no significant changes in spirometry (p > 0.05) or any reported adverse reactions in either group. The results of this study show that high-dose fluticasone is effective in reducing the sputum inflammatory indices in bronchiectasis. Large-scale and long-term studies are indicated to evaluate the effects of inhaled steroid therapy on the inflammatory components in bronchiectasis.