Effect of Inhaled Steroids in Patients with Stable Chronic Obstructive Pulmonary Disease (COPD) and Eosinophilic Bronchitis

Chronic obstructive pulmonary disease (COPD) constitutes an enormous, and growing health problem, the treatment of which has been less than satisfactory till now. Because of the chronic inflammation in the walls of large and peripheral airways as well as in the parenchyma, and as steroids are known for their anti-inflammatory effects, the latter had been investigated in more than 100 studies, however, the results are controversial. Recently, a group of COPD patients with high sputum eosinophilic count showed improvements clinically, functionally and in health status, following high dose of inhaled steroids. Thus the aim of the current study was to determine whether sputum eosinophilia (sputum eosinophils 3%); in stable COPD patients can predict clinical benefits from treatment by high dose of inhaled steroids. Out of the 80 COPD patients who fulfilled the inclusion criteria and agreed to participate on this study, only 14 cases (Group I) showed evidence of high eosinophilic count in induced sputum, they received no oral steroids 2 months preceding the study and they had had no exacerbation one month before the study. They were given high dose of inhaled steroids (fluticasone propionate 500 microgram twice per day by Diskus) for one month. Another 14 patients (without sputum eosinophila) were also included in this study as Group II. They received inhaled steroids at a dose similar to those of group I. Patients of Group I showed decrease in sputum eosinophilia, accompanied by marked clinical improvement, however, there was no detectable statistical difference in functional improvement. Those patients of Group II showed no improvement neither clinically nor functionally, denoting lack of beneficial effect of inhaled steroids in COPD patients with no sputum eosinophilia.