Elsevier

Respiratory Medicine

Volume 105, Issue 12, December 2011, Pages 1853-1860
Respiratory Medicine

Sputum inflammation predicts exacerbations after cessation of inhaled corticosteroids in COPD

https://doi.org/10.1016/j.rmed.2011.07.002Get rights and content
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Summary

Introduction

The GOLD guidelines advocate not to institute inhaled corticosteroids (ICS) in patients with mild-to-moderate COPD. However, many patients do use ICS and in some patients, withdrawal is associated with deteriorating lung function and increased exacerbation rates. Unfortunately, physicians do not know in which patients they can stop ICS treatment safely.

Aim

To identify predictors of COPD exacerbations after ICS withdrawal.

Methods

During ICS treatment, post-bronchodilator spirometry, body plethysmography, and health status assessment were performed in 68 COPD patients using ICS. Additionally, sputum cell differentials, supernatant leukotriene B4, eosinophilic cationic protein, and myeloperoxidase, serum C-reactive protein and soluble intracellular adhesion molecule, and urinary desmosine were assessed. Sputum was also analysed for mRNA levels of haemoxygenase-1, tumour necrosis factor-α, RANTES, interleukin 5(IL-5), IL-10, IL-12, IL-13, transforming growth factor-β, and interferon-γ.

Statistics

Cox regression analyses were performed using time to exacerbation as outcome variable to identify significant hazards for a COPD exacerbation after ICS withdrawal.

Results

Higher sputum % eosinophils, higher sputum MPO/neutrophil level, longer duration of COPD symptoms, <40 packyears smoking, and ICS withdrawal in November, December or January were significant hazards (all p < 0.05) for experiencing a COPD exacerbation after ICS withdrawal in a monovariate model. In a multivariate model, all factors proved independent predictors except for sputum MPO/neutrophil level.

Conclusions

Decisions on whether or not inhaled corticosteroids can be safely withdrawn in mild-to-moderate COPD can be facilitated by assessment of sputum inflammation, particularly eosinophil numbers, next to packyears smoking, season, and duration of COPD symptoms.

Keywords

Inhaled corticosteroids
Airway inflammation
Eosinophil
Sputum induction
COPD exacerbation

Cited by (0)

This study has been registered at http://www.clinicaltrials.gov, ID: NCT00239278.