Inhaled Corticosteroids Do Not Influence the Early Inflammatory Response and Clinical Presentation of Hospitalized Subjects With COPD Exacerbation

Autores de IIS La Fe

• Juan Francisco Guerrero Martinez

  Autor

• Rosario Menéndez Villanueva

  Autor

• Araceli Huerta Marco

  Autor

• Raquel Martínez Tomás

  Autor

• Alexandra Gimeno Cardells

  Autor

• Antonio Torres Marti

  Autor

Participantes ajenos a IIS La Fe

• Crisafulli E
• Soler N

Grupos

• Infecciones Respiratorias

Abstract

BACKGROUND: Inhaled corticosteroids are anti-inflammatory medications that can down-regulate the immunologic response in patients with COPD; however, their role at onset of COPD exacerbation is still not understood. The aim of this study was to assess the early inflammatory response and clinical presentation of patients with COPD exacerbation mediated by inhaled corticosteroids. METHODS: Prospective data were collected on 123 hospitalized subjects with COPD exacerbation over a 30-month period at 2 Spanish university hospitals. Based on domiciliary use, comparative analyses were performed between subjects who did not use inhaled corticosteroids (n = 58) and subjects who did (n = 65). Measurements of serum biomarkers were recorded on admission to the hospital (day 1) and on day 3; clinical, physiological, microbiological, and severity data and mortality/readmission rates were also recorded. RESULTS: At days 1 and 3, both groups showed a similar inflammatory response; fluticasone produced lower levels of interleukin-8 compared with budesonide (P < .01). All clinical features considered were similar in the 2 groups; multivariate analysis predicting clinical complications on hospitalization showed air-flow obstruction severity as the only predictive factor (odds ratio 3.13, 95% CI 1.13-8.63, P = .02). CONCLUSIONS: Our study demonstrates a lack Of inhaled corticosteroid influence in the early systemic inflammatory response to and clinical presentation of COPD exacerbation.

Keywords

• chronic obstructive pulmonary disease; exacerbation; inhaled corticosteroids; systemic inflammation; clinical presentation