Chest
Volume 126, Issue 2, August 2004, Pages 375-381
Journal home page for Chest

Clinical Investigations
COPD
Characteristics of Airway Inflammation and Bronchodilator Reversibility in COPD: A Potential Guide to Treatment

https://doi.org/10.1378/chest.126.2.375Get rights and content

Study objectives:

The management of stable patients with COPD depends on the severity of symptoms and airflow limitation. Regarding inflammation, corticosteroids are the only medications that are recommended for use, and only under restricted circumstances. Corticosteroids tend to undertreat or overtreat patients with COPD when only clinical manifestations and the findings of simple spirometry are considered. Accordingly, our aim was to survey the characteristics of airway inflammation in stable COPD patients, and to assess the interrelations among inflammatory cells, inflammatory mediators, bronchodilator reversibility, and pulmonary function. Factors related to airway inflammation and bronchodilator reversibility may be important in the management of stable COPD patients.

Methods:

A total of 88 stable patients with smoking-related COPD were recruited into the study. All patients were steroid-free, and had been treated with theophylline, oral β2-agonist agents, anticholinergic agents, and possibly mucolytic agents. Bronchodilator tests and sputum induction were performed to evaluate bronchodilator reversibility, and numbers of inflammatory cells and mediators (eg, interleukin [IL]-8, eotaxin, and regulated on activation, normal T cells expressed and secreted [RANTES]).

Results:

Thirty-one of 48 patients (64.6%) who had bronchodilator reversibility, and 19 of 40 patients (47.5%) without bronchodilator reversibility had sputum eosinophilia (median, 8.0% and 7.0%, respectively). FEV1 showed a significant inverse correlation with the number of sputum neutrophils. The correlation coefficient for postbronchodilator FEV1 vs the percentage of neutrophils in patients with nonreversible COPD was higher than that in those with reversible COPD. The levels of IL-8 were closely associated with the percentage of neutrophils. The sputum concentrations of IL-8 and albumin were significantly higher in patients with nonreversible COPD than in those with reversible COPD. A significant inverse correlation was found between bronchodilator response (ie, ΔFEV1 and ΔFVC) and prebronchodilator FEV1.

Conclusions:

Eosinophilic inflammation may play a substantial role in COPD, while neutrophils and IL-8 may have a great influence on nonreversible obstructive airways. The assessment of airway inflammation and bronchodilator responses can help the selection of specific therapies and the prediction of clinical outcomes for COPD patients.

Section snippets

Subjects

This was a prospective study to investigate airway inflammation and bronchodilator reversibility in stable patients with smoking-related COPD who used medications regularly. Eighty-eight male patients were recruited from our outpatient clinic. COPD was diagnosed according to the Global Initiative for Chronic Obstructive Lung Disease guidelines1 from observing symptoms of progressive shortness of breath, productive cough, and occasional wheezing. All patients were treated with theophylline, oral

Results

The characteristics of all study subjects are listed in Table 1. The two groups of COPD patients were similar in age and baseline pulmonary function except for bronchodilator reversibility of FEV1 and FVC.

Discussion

The results of this study show that a substantial degree of eosinophilic inflammation can be observed in COPD, although no study subjects had a history of asthma and allergy, and all had received diagnoses that had been determined according to the Global Initiative for Chronic Obstructive Lung Disease guidelines.1 Sputum neutrophils, but not eosinophils, in stable COPD patients were significantly negatively correlated with FEV1 percent predicted. These correlations were more robust in COPD

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    This work was supported by research grants from Taipei Veterans General Hospital (VGH93–185). There is no potential conflict of interest involved in this study.

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