Objective The therapeutic benefit of inhaled corticoids in bronchiectasis not due to cystic fibrosis is still not well documented. The aim of the present study was to assess the efficacy and safety of inhaled corticoids in this disease. Setting This study was conducted at a tertiary university hospital in the city of Barcelona, Catalonia, (Spain). Method A prospective, double-blind, parallel, placebo-masked study was conducted. Seventy-seven patients (40 women; mean age: 68 years) were randomly assigned to receive either 400 mcg budesonide twice daily or placebo and were regularly reviewed for six months. Results Differences in forced vital capacity and forced expiratory volume in the first second between the beginning and end of the study were not significantly lower in the budesonide group than in the placebo group, either in absolute values [−17.4 (386.9) versus −21.4 (375.5)] or in percentages [−1.9(9.5) versus −2.8 (11.6)]. Microbiological criteria applied to evaluate changes between the beginning and end of the study showed no worsening in the budesonide group compared with the control group, whereas a non-significant improvement was obtained in 8.1 % of cases in the budesonide group compared to 3 % in the placebo group. Although significance was only achieved for sputum eosinophils (p = 0.021), a consistent tendency towards improvement was also observed in secondary end-points (symptoms, number and duration of exacerbations, quality of life, sputum cytology and interleukin-8) in the budesonide group. Conclusion Although further studies are required, inhaled corticoid treatment may be efficacious and safe in bronchiectasis not due to cystic fibrosis.
Bronchiectasis Budesonide Inhaled corticoid
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The authors wish to thank Christine O’Hara for her help with the English translation of the manuscript and Rosa Llòria for editorial assistance.
This work was supported by the Catalan Foundation of Pneumology (FUCAP) through a grant attributed to RH, MED and RO.
Wilson R. The pathogenesis and management of bronchial infections: the vicious cycle of respiratory decline. Rev Contemp Pharmacother. 1992;3:103–12.Google Scholar
Derendorf H, Nave R, Drollmann A, Cerasoli F, Wurst W. Relevance of pharmacokinetics and pharmacodynamics of inhaled corticosteroids to asthma. Eur Respir J. 2006;28:1042–50.PubMedCrossRefGoogle Scholar
From the Global Strategy for Asthma Management and Prevention. Global Initiative for Asthma (GINA) 2010. Available from: http://www.ginasthma.org.
From the Global Strategy for the Diagnosis, Management and Prevention of COPD. Global initiative for chronic obstructive lung disease (GOLD) 2010. Available from: http://www.goldcopd.org.
King P. Is there a role for inhaled corticosteroids and macrolide therapy in bronchiectasis? Drugs. 2007;67:965–74.PubMedCrossRefGoogle Scholar
Inhaled corticosteroids for cystic fibrosis (Review). The Cochrane collaboration 2009.Google Scholar
Inhaled corticosteroids for bronchiectasis (Review). The Cochrane collaboration 2009.Google Scholar
Giner J, Basualdo LV, Casan P, Hernandez C, Macián V, Martínez I, et al. Normativa sobre la utilización de fármacos inhalados. Recomendaciones SEPAR. Arch Bronconeumol. 2000;36:34–43.PubMedGoogle Scholar
Casals T, Nunes V, Palacio A, Giménez J, Gaona A, Ibáñez N, et al. Cystic fibrosis in Spain: high frequency of mutation G542X in the Mediterranean coastal area. Hum Genet. 1993;91:66–70.PubMedCrossRefGoogle Scholar
Portenoy RK, Thaler HT, Kornblith AB, Lepore JM, Friedlander-Klar H, Kiyasu E, et al. The Memorial Symptom Assessment Scale: an instrument for the evaluation of symptom prevalence, characteristics and distress. Eur J Cancer. 1994;30:1326–36.CrossRefGoogle Scholar
Ferrer M, Alonso J, Prieto L, Plaza V, Monso E, Marrades R, et al. Validity and reliability of the St George’s Respiratory Questionnaire alter adaptation to a different language and culture: the Spanish example. Eur Respir J. 1996;9:1160–6.PubMedCrossRefGoogle Scholar
Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, et al. Standardisation of spirometry. Eur Respir J. 2005;26:319–38.PubMedCrossRefGoogle Scholar
Pizzichini E, Pizzichini MM, Efthimiadis A, Hargreave FE, Dolovich J. Measurement of inflammatory indices in induced sputum: effects of selection of sputum to minimize salivary contamination. Eur Respir J. 1996;9(6):1174–80.PubMedCrossRefGoogle Scholar
Murray PR, Washington JA. Microscopic and bacteriologic analysis of expectorated sputum. Mayo Clinic Proc. 1975;50:339–44.Google Scholar
Bauer AW, Kirby WMM, Sherris JC, Turck M. Antibiotic susceptibility testing by a standardized single disk method. Am J Clin Pathol. 1966;45:493–6.PubMedGoogle Scholar
Kapur N, Bell S. Kolbe J, Chang AB. Inhaled steroids for bronchiectasis. Cochrane Database Syst Rev. 2009; 1. Art. no.: CD000996. doi:10.1002/14651858.CD000996.pub2.
Fuschillo S, De Felice A, Balzano G. Mucosal inflammation in idiopathic bronchiectasis: cellular and molecular mechanisms. Eur Respir J. 2008;31:396–406.PubMedCrossRefGoogle Scholar
Phua GC, Macintyre NR. Inhaled corticosteroids in obstructive airway disease. Respir Care. 2007;52:852–8.PubMedGoogle Scholar
Sutherland R, Allmers H, Ayas NT, Venn J, Martin RJ. Inhaled corticosteroids reduce progression of airflow limitation in chronic obstructive pulmonary disease: a meta-analysis. Thorax. 2003;58:937–41.PubMedCrossRefGoogle Scholar
Escotte S, Tabary O, Dusser D, Majer-Teboul C, Puchelle E, Jacquot J. Fluticasone reduces IL-6 and IL-8 production of cystic fibrosis bronchial epithelial cells via IKK-β kinase pathway. Eur Respir J. 2003;21:574–81.PubMedCrossRefGoogle Scholar
Elborn JS, Johnston B, Allen F, Clarke J, McGarry J, Varguese G. Inhaled steroids in patients with bronchiectasis. Respir Med. 1992;86:121–4.PubMedCrossRefGoogle Scholar
Tsang KWT, Ho PL, Lam WK, Ip MSM, Chan KN, Ho CS, et al. Inhaled fluticasone reduces sputum inflammatory indices in severe bronchiectasis. Am J Respir Crit Care Med. 1998;158:723–7.PubMedGoogle Scholar
Joshi JM, Sundaram P. Role of inhaled steroids in stable bronchiectasis. Indian Pract. 2004;57(4):243–5.Google Scholar
Tsang KW, Tan KC, Ho PL, Ooi GC, Ho JC, Mak J, et al. Inhaled fluticasone in bronchiectasis: a 12 month study. Thorax. 2005;60:239–43.PubMedCrossRefGoogle Scholar
Martínez-García MA, Perpiñá-Tordera M, Román-Sánchez P, Soler-Cataluña JJ, Carratalá A, Pastor M. Inhaled steroids improve quality of life in patients with steady-state bronchiectasis. Respir Med. 2006;100:1623–32.PubMedCrossRefGoogle Scholar
Angrill J, Agustí C, de Celis R, Rañó A, Gozalez J, Solé T, et al. Bacterial colonisation in patients with bronchiectasis: microbiological pattern and risk factors. Thorax. 2002;57:15–9.PubMedCrossRefGoogle Scholar