Stable COPD: predicting benefit from high dose inhaled corticosteroid treatment

¹ Firestone Institute for Respiratory Health, St. Joseph's Healthcare and McMaster University, Hamilton, Ontario
² Firestone Institute for Respiratory Health, St. Joseph's Healthcare and McMaster University, Hamilton, Ontario; and NUPAIVA - Universidade Federal de Santa Catarina, Florianopolis, Brazil
³ Centre de recherche, Hôpital Laval, Institut universitaire de cardiologie et de pneumologie de l'Université Laval, Quebec

^* To whom correspondence should be addressed. E-mail: pizzichi{at}matrix.com.br.

	Abstract

The role of inhaled corticosteroids in the management of chronic obstructive pulmonary disease (COPD) remains controversial. The purpose of this study was to evaluate whether sputum eosinophilia (3%) predicts clinical benefit from inhaled corticosteroid treatment in patients with stable moderate-severe smokers COPD.

Forty consecutive patients with effort dyspnoea (mean age 67 years; 52 pack-year smoking history; post-bronchodilator forced expiratory volume in one second (FEV₁) <60% predicted, consistent with moderate-severe smoking-related chronic airflow limitation) were enrolled. Subjects were treated with inhaled placebo followed by inhaled budesonide (Pulmicort Turbuhaler® 1600 µg·day^-1), each given for 4 weeks. While the treatment was single-blind (subject level), sputum cell counts before and after treatment interventions were double-blind, thus removing bias. Outcome variables included spirometry, quality of life assessment and 6-minute walk test.

Sputum eosinophilia was present in 38% of subjects. In these, budesonide treatment normalized the eosinophil counts and, in comparison to placebo treatment, resulted in clinically significant improvement in the dyspnoea domain of the disease specific chronic respiratory questionnaire (0.8 vs. 0.3) and a small but statistically significant improvement in post-bronchodilator spirometry (FEV₁ 100 ml vs. 0 ml) (p<0.05).

We conclude that sputum eosinophilia predicts short-term clinical benefit from high dose inhaled corticosteroid treatment in patients with stable moderate-severe COPD.

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