Long-term effects of inhaled corticosteroids on sputum bacterial and viral loads in COPD

Inhaled corticosteroid-containing medications reduce the frequency of COPD exacerbations (mainly infectious in origin) while paradoxically increasing the risk of other respiratory infections The aim was to determine the effects of inhaled corticosteroids on airway microbial load in COPD patients and...

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Bibliographic Details
Published in:The European respiratory journal Vol. 50; no. 4
Main Authors: Contoli, Marco, Pauletti, Alessia, Rossi, Maria Rita, Spanevello, Antonio, Casolari, Paolo, Marcellini, Andrea, Forini, Giacomo, Gnesini, Giulia, Marku, Brunilda, Barnes, Neil, Rizzi, Andrea, Curradi, Giacomo, Caramori, Gaetano, Morelli, Paolo, Papi, Alberto
Format: Journal Article
Language:English
Published: England 01.10.2017
Subjects:
Administration, Inhalation
Bacterial Load - drug effects
Bacterial Load - methods
Bronchodilator Agents - administration & dosage
Bronchodilator Agents - adverse effects
Drug Monitoring - methods
Eosinophils - pathology
Female
Fluticasone - administration & dosage
Fluticasone - adverse effects
Forced Expiratory Volume
Glucocorticoids - administration & dosage
Glucocorticoids - adverse effects
Humans
Long Term Adverse Effects - diagnosis
Long Term Adverse Effects - microbiology
Male
Middle Aged
Pulmonary Disease, Chronic Obstructive - blood
Pulmonary Disease, Chronic Obstructive - diagnosis
Pulmonary Disease, Chronic Obstructive - drug therapy
Pulmonary Disease, Chronic Obstructive - microbiology
Respiratory Function Tests
Respiratory Tract Infections - diagnosis
Respiratory Tract Infections - microbiology
Salmeterol Xinafoate - administration & dosage
Salmeterol Xinafoate - adverse effects
Sputum - microbiology
Treatment Outcome
Viral Load - drug effects
Viral Load - methods
ISSN:1399-3003, 1399-3003
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Summary:Inhaled corticosteroid-containing medications reduce the frequency of COPD exacerbations (mainly infectious in origin) while paradoxically increasing the risk of other respiratory infections The aim was to determine the effects of inhaled corticosteroids on airway microbial load in COPD patients and evaluate the influence of the underlying inflammatory profile on airway colonisation and microbiome.This is a proof-of-concept prospective, randomised, open-label, blinded endpoint study. Sixty patients with stable moderate COPD were randomised to receive one inhalation twice daily of either a combination of salmeterol 50 μg plus fluticasone propionate 500 μg or salmeterol 50 μg for 12 months. The primary outcome was the change of sputum bacterial loads over the course of treatment.Compared with salmeterol, 1-year treatment with salmeterol plus fluticasone was associated with a significant increase in sputum bacterial load (p=0.005), modification of sputum microbial composition and increased airway load of potentially pathogenic bacteria. The increased bacterial load was observed only in inhaled corticosteroid-treated patients with lower baseline sputum or blood eosinophil (≤2%) levels but not in patients with higher baseline eosinophils.Long-term inhaled corticosteroid treatment affects bacterial load in stable COPD. Lower eosinophil counts are associated with increased airway bacterial load.
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ISSN:1399-3003
1399-3003
DOI:10.1183/13993003.00451-2017