Long-term effects of inhaled corticosteroids on sputum bacterial and viral loads in COPD
Long-term effects of inhaled corticosteroids on sputum bacterial and viral loads in COPD
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DOI：
10.1183/13993003.00451-2017
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发表时间：
2017-10-01
影响因子：
24.3
通讯作者：
Papi, Alberto
中科院分区：
文献类型：
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作者：
Cantoli, Marco;Pauletti, Alessia;Papi, Alberto
吸入性含糖皮质激素药物可降低COPD急性加重（主要是感染性）的频率，但却增加了其他呼吸道感染的风险。目的是确定吸入皮质类固醇对COPD患者气道微生物负荷的影响，并评估潜在炎症特征对气道定植和微生物组的影响。这是一项概念验证前瞻性、随机、开放标签、盲法终点研究。60例稳定的中度COPD患者随机接受沙美特罗50 μ g+丙酸氟替卡松500 μ g或沙美特罗50 μ g联合吸入，每日两次，持续12个月。与沙美特罗相比，沙美特罗+氟替卡松治疗1年后，痰菌量显著增加（p=0.005），痰菌组成改变，气道潜在致病菌量增加。细菌负荷增加仅见于基线痰液或血嗜酸性粒细胞较低的吸入性皮质类固醇治疗患者（
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 mu g plus fluticasone propionate 500 mu g or salmeterol 50 mu g 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 (