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

2016 ◽  
Vol 49 (1) ◽  
pp. 1600839 ◽  
Author(s):  
Lisette I.Z. Kunz ◽  
Nick H.T. ten Hacken ◽  
Thérèse S. Lapperre ◽  
Wim Timens ◽  
Huib A.M. Kerstjens ◽  
...  
Keyword(s):  
Lung Function ◽  
Airway Inflammation ◽  
Inhaled Corticosteroids ◽  
Term Treatment ◽  
Chronic Obstructive ◽  
Lung Function Decline ◽  
Cell Counts ◽  
Long Term Treatment ◽  
Severe Copd

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 (500 µg twice daily), 30-month treatment with fluticasone/salmeterol (500/50 µg 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 7.5 years (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 0–50% 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 1.87–3.84), CD4+ (1.91, 95% CI 1.33–2.75) and CD8+ cells (1.71, 95% CI 1.15–2.53), and mast cells (1.91, 95% CI 1.36–2.68). The sputum total cell counts increased significantly in GL2 (1.90, 95% CI 1.42–2.54), as did counts of macrophages (2.10, 95% CI 1.55–2.86), neutrophils (1.92, 95% CI 1.39–2.65) and lymphocytes (2.01, 95% CI 1.46–2.78).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.

Impact of long-term treatment with low-dose inhaled corticosteroids on the bone mineral density of chronic obstructive pulmonary disease patients: Aggravating or beneficial?

Respirology ◽  
2012 ◽  
Vol 18 (1) ◽  
pp. 147-153 ◽  
Author(s):  
ALEXANDROS G. MATHIOUDAKIS ◽  
STAVROULA G. AMANETOPOULOU ◽  
IOANNIS P. GIALMANIDIS ◽  
VICTORIA CHATZIMAVRIDOU-GRIGORIADOU ◽  
GERASIMOS SIASOS ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Chronic Obstructive Pulmonary Disease ◽  
Low Dose ◽  
Inhaled Corticosteroids ◽  
Term Treatment ◽  
Chronic Obstructive ◽  
Mineral Density ◽  
Obstructive Pulmonary Disease ◽  
Long Term Treatment

scholarly journals Results of long-term treatment with short-acting bronchodilators of patients with chronic obstructive pulmonary disease (COPD) and COPD combined with asthma

2005 ◽  
pp. 101-106
Author(s):  
E. I. Shmelev ◽  
M. A. Khmelkova ◽  
Z. O. Grineva
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Lung Function ◽  
Pulmonary Disease ◽  
Term Treatment ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Short Acting ◽  
Copd Patients ◽  
Long Term Treatment

This study was designed to investigate long term treatment effects of short acting bronchodilators on respiratory symptoms, lung function, and the mean pulmonary artery pressure (mPAP) in patients with chronic obstructive pulmonary disease (COPD) and COPD combined with asthma (COPD + BA). The study involved 14 COPD patients and 16 COPD+BA patients, males and females (the average age, 60 yrs) with moderate to severe disease and the mPAP higher than 20 mm Hg. Clinical examination with scoring of cough, sputum, dyspnea, and lung auscultation signs; spirometry, ECG, echocardiography, chest X ray, and blood analysis were used. Clinical status and lung function were evaluated primarily and in 4, 12, and 24 wks; the mPAP was measured initially and in 12 and 24 wks. Before the study no one patient received persistent supporting therapy with bronchodilators, 15 COPD + BA patients and 7 COPD patients were given inhaled steroids. Persistent therapy of all the patients with Berodual 2 doses 4 times daily for 24 wks resulted in improvement in the clinical symptoms and lung function parameters, reduction in mPAP in both the groups but the results were better and they were reached faster in the patients with combined pathology. Thus, the regularly combined therapy with short acting β2 agonists and anticholinergics (Berodual) can be included in the algorithm of therapy of pulmonary hypertension in patients with COPD and COPD + BA.

Long-Term Treatment with ‘Duovent’ in Elderly Patients Affected by Chronic Obstructive Lung Disease

Respiration ◽  
1986 ◽  
Vol 50 (2) ◽  
pp. 245-248
Author(s):  
L. Cecere ◽  
G. Funaro ◽  
G. De Cataldis ◽  
P. Carnicelli ◽  
R. Pinto
Keyword(s):  
Elderly Patients ◽  
Lung Disease ◽  
Obstructive Lung Disease ◽  
Chronic Obstructive Lung Disease ◽  
Term Treatment ◽  
Chronic Obstructive ◽  
Long Term Treatment

scholarly journals Asthma progression and mortality: the role of inhaled corticosteroids

2019 ◽  
Vol 54 (1) ◽  
pp. 1900491 ◽  
Author(s):  
Paul O'Byrne ◽  
Leonardo M. Fabbri ◽  
Ian D. Pavord ◽  
Alberto Papi ◽  
Stefano Petruzzelli ◽  
...  
Keyword(s):  
Lung Function ◽  
Pulmonary Function ◽  
Inhaled Corticosteroids ◽  
Administrative Databases ◽  
Rapid Decline ◽  
Lung Function Decline ◽  
The Impact ◽  
Asthma Mortality

Overall, asthma mortality rates have declined dramatically in the last 30 years, due to improved diagnosis and to better treatment, particularly in the 1990s following the more widespread use of inhaled corticosteroids (ICSs). The impact of ICS on other long-term outcomes, such as lung function decline, is less certain, in part because the factors associated with these outcomes are incompletely understood. The purpose of this review is to evaluate the effect of pharmacological interventions, particularly ICS, on asthma progression and mortality. Furthermore, we review the potential mechanisms of action of pharmacotherapy on asthma progression and mortality, the effects of ICS on long-term changes in lung function, and the role of ICS in various asthma phenotypes.Overall, there is compelling evidence of the value of ICS in improving asthma control, as measured by improved symptoms, pulmonary function and reduced exacerbations. There is, however, less convincing evidence that ICS prevents the decline in pulmonary function that occurs in some, although not all, patients with asthma. Severe exacerbations are associated with a more rapid decline in pulmonary function, and by reducing the risk of severe exacerbations, it is likely that ICS will, at least partially, prevent this decline. Studies using administrative databases also support an important role for ICS in reducing asthma mortality, but the fact that asthma mortality is, fortunately, an uncommon event makes it highly improbable that this will be demonstrated in prospective trials.

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