Environmental activist Chris
Hobbs, 57, fights for clean air so others can breathe
easy, though chronic obstructive pulmonary disease (COPD)
makes breathing tough for him. Unfortunately, his rhetoric
isn't the only inflammatory thing around. His elevated
serum levels of C-reactive protein (CRP) are a sign of
lung inflammation, which in turn is linked to cardiovascular
problems, and even death, in COPD patients. The good news
is that Canadian researchers reported in the October 1
issue of the American Journal of Respiratory and Critical
Care Medicine that fluticasone and prednisone reduce
CRP in COPD patients.
Dr Paul Man, of Vancouver's St
Paul's Hospital, and his colleagues had 41 patients
with mild to moderate COPD prepare for the study � la
Bill Clinton, by abjuring drug inhalation for four weeks,
although corticosteroids, not marijuana, were involved.
As patients' corticosteroid levels fell, CRP levels
increased by 71%.
For the subsequent two weeks, patients
inhaled fluticasone, gulped prednisone or took a placebo.
In the fluticasone crowd, CRP levels dropped back by
50%, while those treated with oral prednisone fared
even better with a 63% drop. The placebo group had no
significant drop in CRP.
During the next 16 weeks, all patients
inhaled fluticasone. After eight weeks, CRP levels were
lower than before the initial four-week corticosteroid-free
period. This suggests that oral and inhaled corticosteroids
have cardio-protective effects in COPD patients.
"The use of inhaled corticosteroids
in COPD is controversial. We are of the opinion, on
the basis of our own studies and those of others, that
[inhaled cortocosteroid] is beneficial," said Dr Man.
"Not all the experts in the area endorse such practice."
Indeed, these encouraging results require bigger studies
before their real significance is apparent. But, for
now, reduced systemic inflammation resulting from corticosteroid
use "raise[s] the possibility that [corticosteroids]
could have salutary effects on cardiovascular morbidity
and mortality in COPD," said Dr Man.
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