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Inflammatory Characteristics, Reversibility May Help Guide COPD Therapy

NEW YORK (Reuters Health) – A substantial degree of eosinophilic inflammation is found in patients with COPD, and high levels of neutrophils and interleukin [IL]-8 are associated with nonreversible obstructive airways, Taiwanese researchers report. They say assessment of these characteristics “can help the selection of specific therapies.”

“The management of stable patients with COPD depends on the severity of symptoms and airflow limitation,” Dr. Diahn-Warng Perng, of Taipei Veterans General Hospital, and colleagues write in the August issue of Chest.

“Regarding inflammation, corticosteroids are the only medications that are recommended for use, and only under restricted circumstances,” they point out, but this approach may “undertreat or overtreat patients with COPD” when based only on clinical manifestations and spirometry.

To assess factors that might be important in guiding management of COPD, the researchers examined the characteristics of airway inflammation in 88 patients with smoking-related COPD. In addition, they evaluated the interrelationship of inflammatory cells, inflammatory mediators, bronchodilator reversibility, and pulmonary function.

All patients included in the study were steroid-free, and had been treated with theophylline, oral beta-2 agonists, anticholinergic agents, and possibly mucolytic agents. The team conducted bronchodilator tests to assess reversibility and sputum induction to examine inflammatory cells and mediators.

Of 48 patients who had bronchodilator reversibility, 31 (64.6%) had sputum eosinophilia (median, 8.0%). In comparison, 19 of 40 patients (47.5%) without bronchodilator reversibility had sputum eosinophilia (median, 7.0%).

A significant inverse correlation was observed between neutrophils and FEV1 percent predicted, and this association was stronger in COPD patients without reversibility, Dr. Perng and colleagues found.

Also, levels of IL-8 were significantly associated with the percentage of neutrophils. Compared with patients with reversible COPD, those with nonreversible COPD had significantly higher sputum concentrations of IL-8 and albumin.

“A substantial degree of eosinophilic inflammation can be observed in COPD, although no study subjects had a history of asthma and allergy,” the team concludes. Moreover, neutrophils and IL-8 are associated with deterioration in pulmonary function.

By assessment of these factors, the researchers say, “We can provide more specific and useful therapies and help to predict clinical outcomes for patients with COPD.”

Chest 2004;126:375-381.


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