Inhalation Efficacy Of Glucocorticoid In AECOPD Therapy

Chronic Obstructive Pulmonary Disease (COPD) is a chronic inflammation disease characterized by airflow limitation that is not fully reversible. The pathogenesis is not yet clear, but it is generally thought that the chronic inflammation in airway and lung take an important role. In addition to inflammation, protease-antiprotease imbalance, oxidation-antioxidation imbalance and infection are also involved in the pathogenesis of COPD.The clinical course of COPD is divided into exacerbation stage and stable stage, exacerbation is the most leading cause of mortality, therefore, we must pay more attention to diagnosis and treatment of COPD, and particularly AECOPD should be placed in the most important position.The treatment of COPD includes oxygen therapy, antibiotics, bronchodilators, glucocorticosteroids, respiratory stimulants, and ventilatory support and so on, among those methods glucocorticoid is one of key drugs to the treatment of COPD. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease (GOLD) indicates that systemic glucocorticoid is an effective drug for the treatment of acute exerbation of chronic obstructive pulmonary disease (AECOPD), and has been approved by many scholars. But COPD often occurres in the middle and old crowds, long-term and repeated application of systemic glucocorticoid may inevitably cause serious adverse reactions, leading to further decline in the life quality of patients, and increasing the burden of society and economy. While inhalation glucocorticoid acts directly on target organs, which has avoided the influence on non-pathological organs, so reduces the side effect on whole body, but its' role in the treatment of AECOPD has not yet achieved consensus.The objective is to study the influence of the inhaled glucocorticoids on clinical symptoms, the lung function, cytokines interleukin 8 (IL-8) and the tumor necrosis factor alpha (TNF-α) in the serum and the induction phlegm of patients with AECOPD, and to discuss efficacy of inhaled glucocorticoids on AECOPD, and pathogenesis of chronic obstructive pulmonary disease.The subjects were 44 hospitalization patients with the diagnosis for the acute exacerbation of chronic obstructive pulmonary disease (AECOPD) (the lung functionⅡLevel withⅢLevel) in the First Clinical Hospital of Jilin University between March 2007 and October 2008, and 20 healthy volunteers, who took physical examination at examination center in the First Clinical Hospital of Jilin University. 20 healthy volunteers belonged to the control group, and the level of IL-8 and TNF-αin the serum was detected. 44 hospitalization patients were divided into two groups, namely inhalation group and non-inhalation group, there was no statistical deference in gender and age of patients between two groups. 21 cases in the non- inhalation group accepted conventional treatments, such as the antibiotics, the doxofyllineInjection etc.; 23 cases in the inhalation group accepted inhaled glucocorticoid (budesonide suspension 2mg + 0.9% saline 2ml) depending on actuation of high pressure oxygen twice daily on the bases of above treatment; The course of treatment was two weeks. Clinical symptoms grading, the lung function, the level of IL-8 and TNF-αin the serum and the sputum were measured for patients of inhalation group and non-inhalation group before treatment and after treatment respectively, and demonstrated whether there was statistics difference of each index between two groups. And comparing with the level of IL-8 and TNF-αin the serum of the control group, Result:1. Before the treatment, clinical symptoms grading of patients in the non-inhalation group and inhalation group were no statistical deferences (p>0.05). After the treatment, clinical symptoms grading of patients in two groups reduced, and it reduced significantly in inhalation group (p<0.05).2. Compared with the control group, there was no significant difference (p <0.05) in the lung function FEV1, FEV1%pre and FEV1/FVC in non-inhalation group and the inhalation group before and after the treatment respectively. After the treatment, the above lung function indicators of the patients in two groups were increased, there was statistical deference compared with these before the treatment (p<0.05). And compared the above lung function indicators of the patients between two groups after the treatment, more increasing was observed in inhalation group (p<0.05).3. Before the treatment, the level of IL-8, TNF-αin serum of the non-inhalation group and the inhales group was higher than this in the control group obviously (P<0.05). After treatment, that was significantly lower than that before treatment (P <0.05), but slightly higher than that in the control group. There was no diferrence in the level of IL-8, TNF-αin serum between the non-inhalation group and the inhales group after the treatment.4. After treatment, the level of IL-8, TNF-αin sputum of the non-inhalation group and the inhales group was significantly lower than that before treatment (P <0.05), and more obvious droping was observed in inhalation group (P<0.05).5. There was a negative correlation between the level of IL-8, TNF-αin serum, sputum and FEV1 (r =-0.5849, -0.5651, -0.6134, -0.5276, respectively), FEV1%pre (r =-0.5067, -0.4763, -0.5456, -0.4743, respectively) respectively (P <0.05).Conclusion:1. IL-8 and TNF-αparticipated in the pathophysiological process of COPD, throughout the airway inflammation process of COPD, which are sensitive index reflecting whether COPD patients presented acute infection and evaluating severity of illness, they take important position in the pathogenesis of COPD, so they might be regarded as new targets in the treatment of COPD.2. Compared with conventional treatment, inhaled glucocorticoid can relieve clinical sysmptom more effectively, and elevate the quality of life.3. Inhaled glucocorticoid can improve the lung fuction, lessen obstruction in airway and excessive gas filing, but can not prevent the progressively inclining tendency of lung fuction.4. Inhaled glucocorticoid can lighten the airway inflammation, the local anti-inflammatory action is better than the systematic anti-inflammatory action, it is another choice of glucocorticoid treatment, and is the efficient method in the treatment of AECOPD.