NEW DEVELOPMENTS IN THE TREATMENT OF COPD

Department of Respiratory Medicine, National Institute of Tuberculosis and Lung Diseases, Warsaw, Poland.Inhaled corticosteroids (ICS) are widely used for the treatment of COPD despite ofcontroversial statements concerning their efficacy. The use of N-acetylcysteine(NAC), a mucolytic drug with antioxidant properties, is less clear, but it maycounteract the oxidant-antioxidant imbalance in COPD. The aim of this study was toevaluate whether treatment of COPD patients with ICS or NAC is able to improveinflammatory indices and to enhance lung function. ICS treatment enhancedprotective markers for oxidative stress such as glutathione peroxidase (GPx) (51.2–5.8 vs. 62.2 –8.6 U/g Hb, P<0.02) and trolox-equivalent antioxidant capacity(TEAC) (1.44 –0.05 vs. 1.52 –0.06 mM, P<0.05). NAC decreased sputum eosinophilcationic protein (318 –73 vs. 163 –30 ng/ml, P<0.01) and sputum IL-8 (429 –80 vs.347 –70 ng/ml, P<0.05). The increased antioxidant capacity prevented an up-regulation of adhesion molecules, since the levels of intracellular adhesion molecule1 (ICAM-1) correlated negatively with GPx (P<0.0001) and TEAC (P<0.0001). Onthe other hand, expression of adhesion molecules was promoted by inflammation,reflected by a positive correlation between the levels of IL-8 and ICAM-1 (P<0.0001).The effects of treatment on lung function were only reflected in the FEV