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Published online before print August 22, 2007
Eur Respir J 2007, doi:10.1183/09031936.00163206
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ORIGINAL ARTICLE

Anti-inflammatory effects of inhaled carbon monoxide in patients with COPD: a pilot study

E. Bathoorn 1, D-J. Slebos 1, D.S. Postma 1, G.H. Koeter 1, A.J.M. van Oosterhout 2, M. van der Toorn 2, H. Marike Boezen 3, H.A.M. Kerstjens 1*

1 Groningen Research Institute for Asthma and COPD (GRIAC), Dept of Pulmonology
2 Laboratory of Allergology and Pulmonary Diseases
3 Dept of Epidemiology, University Medical Center Groningen, University of Groningen, the Netherlands

* To whom correspondence should be addressed. E-mail: h.a.m.kerstjens{at}int.umcg.nl.


  Abstract

In vitro and in vivo studies have shown that carbon monoxide (CO) has both anti-inflammatory and anti-oxidant capacities. Since COPD is characterised by inflammation and oxidative stress, low dose CO could be of therapeutic use.

To investigate the feasibility and anti-inflammatory effects of 100–125 parts per million (ppm) CO inhalation in patients with stable COPD.

Twenty ex-smoking COPD patients, with post- bronchodilator FEV1>1.20 liter and FEV1/FVC<70% were enrolled in a randomised, placebo controlled, cross-over study. Effects on inflammation were measured in induced sputum and blood.

CO inhalation was feasible and patients' vital signs were unaffected. Two hours a day inhalation of low dose CO on 4 consecutive days led to a maximal individual carboxyhaemoglobin of 4.5%. Two exacerbations occurred in the CO period. CO inhalation led to trends in reduced sputum eosinophils (median reduction 0.25% point; p=0.07) and improved responsiveness to methacholine (median PC20 0.85 versus 0.63 mg·mL-1; p=0.098).

Inhalation of 100–125 ppm CO by patients with COPD in a stable phase is feasible and led to trends in reduction of sputum eosinophils and improvement of responsiveness to methacholine. Further studies need to confirm the safety and efficacy in inflammatory lung diseases.

Keywords:  Carbon monoxide, chronic obstructive pulmonary disease, inflammation, sputum induction




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