PURPOSE: There has been increasing interest in using pulmonary biomarkers to understand and monitor the inflammation in the respiratory tract of patients with COPD. Nebulized budesonide has been shown an alternative to systemic corticosteroids in the treatment of nonacidotic exacerbation of COPD. Our study was done to evaluate its impacts on exhaled inflammatory mediators and clinical outcomes.
METHODS: We enrolled 25 patients with mild-moderate exacerbations of COPD(aged 67.7±8.1years,FEV1 percentage of predicted of 59.6±10.2%) and 10 age and sex-matched healthy subjects. In addition to standard treatment, including nebulized beta2-agonists, Ipratropium bromide, antibiotics and supplemental oxygen, all received 2 mg of nebulized budesonide every 6h for 5 days.Dyspnea was assessed according to the modified Borg scale.Exhaled breath condensate(EBC) was collected before and after treatment using the RTubeTM(Respiratory Research, Inc) during 10 min of tidal breathing with the nose clipped. Levels of IL-6, TNF-alpha, LTB4 and IL-8 were measured in EBC by a specific enzyme immunoassay kit.
RESULTS: Significant differences in the concentrations of IL-6,TNF-alpha, LTB4 and IL-8 were observed between patients and individuals without respiratory disease. The mean change in postbronchodilator FEV1 was significantly different after budesonide treatment. Levels of exhaled biomarkers were correlated with dyspnea scores and lung function. Nebulized steroids resulted in reduced levels of IL-6, TNF-alpha, LTB4 and IL-8.
CONCLUSION: Nebulized budesonide may improve airway inflammation by decreasing levels of EBC inflammatory mediator. EBC analysis may be a useful noninvasive way to assess and monitor airway inflammation and response to treatment.
CLINICAL IMPLICATIONS: Nebulized budesonide is an alternative in the treatment of acute exacerbation of chronic obstructive pulmonary disease.
DISCLOSURE: Yi Ming Yuan, None.