NMR-based metabolomics of exhaled breath condensate for assessing the effects of inhaled corticosteroids in COPD patients

Background. Inhalation of thermal water with antioxidant properties is empirically used for COPD.Aims. To evaluate the effects of sulphurous thermal water (reducing agents) on airway oxidant stress and clinical outcomes in COPD.Methods. Forty moderate-to-severe COPD patients were randomly assigned to receive 12-day inhalation with sulphurous thermal water or isotonic saline. Patients were assessed for superoxide anion (O2-) production in the exhaled breath condensate and clinical outcomes at recruitment, the day after the conclusion of the 12-day inhalation treatment, and one month after the end of the inhalation treatment.Results. Inhalation of reducing agents resulted in a significant reduction ofO2-production in exhaled breath condensate of COPD patients at the end of the inhalatory treatment and at followup compared to baseline. A significant improvement in the COPD assessment test (CAT) questionnaire was shown one month after the end of the inhalatory treatment only in patients receiving sulphurous water.Conclusion. Thermal water inhalation produced anin vivoantioxidant effect and improvement in health status in COPD patients. Larger studies are required in order to evaluate whether inhalation of thermal water is able to modify relevant clinical outcomes of the disease (the study was registered at clinicaltrial.gov—identifier:NCT01664767).

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Inflammation, Oxidative Stress and Systemic Effects in Mild Chronic Obstructive Pulmonary Disease

International Journal of Immunopathology and Pharmacology ◽

10.1177/039463200702000411 ◽

2007 ◽

Vol 20 (4) ◽

pp. 753-763 ◽

Cited By ~ 33

Author(s):

M.P. Foschino Barbaro ◽

G.E. Carpagnano ◽

A. Spanevello ◽

M.G. Cagnazzo ◽

P.J. Barnes

Keyword(s):

Healthy Subjects ◽

Respiratory Muscle ◽

Exhaled Breath Condensate ◽

Fat Free Mass ◽

Chronic Obstructive ◽

Exhaled Breath ◽

Respiratory Muscle Strength ◽

Copd Patients ◽

Tnf Α ◽

Breath Condensate

Chronic obstructive pulmonary diseases (COPD) is a pulmonary disease characterized by systemic abnormalities. The aim of this study is to investigate inflammation and systemic effects in mild COPD. Twenty-seven mild stable smoking related COPD patients and 15 age-matched healthy subjects were enrolled in the study. IL-6, TNF-α and IL-4 in plasma, sputum and exhaled breath condensate were measured. We also measured exhaled nitric oxide (NO) and pH in sputum and in breath condensate. Moreover, fat-free mass, body mass index (BMI), respiratory muscle strength, plasma oxidative stress and C-reactive protein (CRP) were measured. Higher concentrations were found of CRP, of diacron reactive oxygen metabolites (DROMs) and of IL-6, TNF-α and IL-4 either in plasma or in supernatant of induced sputum or in exhaled breath condensate of COPD subjects compared to healthy controls. Furthermore, higher concentrations were observed of exhaled NO and lower exhaled pH in breath condensate of COPD when compared with healthy subjects. In the group of COPD patients, the subjects with airway reversibility showed an increase of sputum eosinophils and exhaled NO, whereas the subjects without airway obstruction reversibility showed an increase in sputum neutrophils, TNF-α and IL-6. We also found a trend towards a decrease in fat-free mass and respiratory muscle strength in COPD compared to healthy subjects and a negative correlation between these systemic indices (fat-free mass, maximal inspiratory pressure, maximal expiratory pressure) and TNF-α concentrations in the blood, sputum and breath condensate. We conclude that mild COPD subjects present an increase in inflammatory markers in blood and in airways of similar pattern and furthermore, the neutrophilic pattern of airway inflammation observed in the group of COPD subjects without an airway obstruction reversibility makes it more likely that systemic features are present.

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