Addition of inhaled corticosteroid on combined bronchodilator therapy in patients with COPD

Purpose. Bronchodilator therapy is the first step treatment in patients with COPD. The beneficial effects of corticosteroids either in health status or in airway inflammation in COPD have been previously studied. The aim of this study was to evaluate whether adding inhaled corticosteroids to combined bronchodilator therapy has additive clinical and anti-inflammatory effects in COPD patients. Subjects and methods. Thirty patients with COPD were included in the study. All patients were receiving inhaled anticholinergic and long-acting beta-2 agonist. Inhaled corticosteroid (budesonide 800 μg daily) was added to their current medications for 12 weeks. Before and after this treatment period, spirometric values and arterial blood gas parameters were determined, blood was drawn for measurement of serum inflammatory markers and sputum was induced. Results. All patients were male, mean age was 67.7±8.7 years and duration of disease was 9.7±4.3 years. The induced sputum total cell counts, eosinophil and neutrophil counts decreased with corticosteroid treatment. The induced sputum IL-8 and TNF-alpha levels decreased significantly (IL-8; 835.9±217 versus 378.4±105 pg/ml, p=0.0001, TNF-alpha; 320.7±129 versus 201.3±52 pg/ml, p=0.003). Serum inflammatory markers and sputum LTB4 levels did not change with treatment. Conclusion. These results suggested that the addition of inhaled corticosteroids to combined bronchodilator therapy might have anti-inflammatory effects in patients with COPD.