Nebulized budesonide in the treatment of exacerbations of chronic obstructive pulmonary disease: Efficacy, safety, and effects on the serum levels of soluble differentiation molecules

Abstract

Aim. To investigate the efficacy and safety of nebulized budesonide and systemic glucocorticosteroids (GCS) (SGCS) in the treatment of an exacerbation of chronic obstructive pulmonary disease (COPD) and their effects on the serum concentration of soluble leukocyte differentiation antigens. Subjects and methods. Seventy-eight hospitalized patients with an acute exacerbation of COPD were randomized into two groups: 1) 37 patients took nebulized budesonide 4 mg/day; 2) 41 patients received intravenous prednisolone. The symptoms of COPD, forced expiratory volume in one second (FEV1) and other spirometric indicators, peripheral blood oxygen saturation (SpO2), and adverse events were studied. The serum levels of the soluble adhesion molecules CD50 (sCD50) and CD54 (sCD54) and the lymphocyte activation molecules CD38 (sCD38) and CD25 (sCD25) were investigated by an enzyme immunoassay. Results. There was a significant resolution of the symptoms of COPD, FEV1, and SpO2 in both groups after treatment. The incidence of hyperglycemia episodes was lower in the budesonide group than in the sGCS group. GCSs caused a decrease in the serum level of soluble interleukin-2 receptor (sCD25) in both groups. A prednisolone cycle, unlike a budesonide one, was found to reduce the concentrations of sCD54, sCD50, and sCD38. Conclusion. Nebulized budesonide is an effective and safe alternative to SGCS in treating an exacerbation of COPD. Inhaled GCSs, unlike SGCSs, exhibit anti-inflammatory activity, but exert no immunosuppressive activity.

References

  1. Глобальная стратегия диагностики, лечения и профилактики хронической обструктивной болезни легких (пересмотр 2011). Под ред. Белевского А.С.; пер. с англ. М.: Атмосфера; 2012
  2. Chung K, Adcock I. Multifaceted mechanisms in COPD: inflammation, immunity, and tissue repair and destruction. Eur Respir J. 2008;31(6):1334-1356. doi:0.1183/09031936.00018908.
  3. Хроническая обструктивная болезнь легких. Под ред. Чучалина А.Г. М.: Атмосфера; 2008.
  4. Рабсон А., Ройт А., Делвз П. Основы медицинской иммунологии. Пер. с англ. М.: Мир; 2006.
  5. Lebedev MJ, Krizhanova MA, Vilkov SA et al. Peripheral blood lymphocytes immunophenotype and serum concentration of soluble HLA class I in burn patients. BURNS. 2003;29(2):123-128.
  6. Кравченко Г.А., Новиков Д.В., Птицына Ю.С., Новиков В.В. Сывороточный уровень растворимых форм мембранных антигенов клеток иммунной системы у носителей маркеров вирусного гепатита G. Вопросы вирусологии. 2005;50(5):19-22.
  7. Lebedev MJ, Egorova NI, Sholkina MN et al. Serum levels of different forms of soluble CD38 antigen in burned patients. BURNS. 2004;30(6):552-556.
  8. Novikov VV, Egorova NI, Kurnikov GYu et al. Serum levels of soluble HLA and IL-2R molecules in patients with urogenital Chlamydia infection. Immune-mediated diseases: from theory to therapy book series. Advances In Experl Medi Biol. 2007;601:285-289.
  9. Global Strategy for the Diagnosis, Management and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2015. Доступно по: http://www.goldcopd.org/. Ссылка активна на 20.07.2015.
  10. Чучалин А.Г., Авдеев С.Н., Айсанов З.Р., Белевский А.С., Лещенко И.В., Мещерякова Н.Н., Овчаренко С.И., Шмелев Е.И. Федеральные клинические рекомендации по диагностике и лечению хронической обструктивной болезни легких. Пульмонология. 2014;3:15-54.
  11. Овчаренко С.И., Передельская О.А., Морозова Н.В., Маколкин В.И. Небулайзерная терапия бронхолитиками и суспензией пульмикорта в лечении тяжелого обострения бронхиальной астмы. Пульмонология. 2003;6:75-83.
  12. Rodrigo G. Rapid Effects of Inhaled Corticosteroids in Acute Asthma: an evidence-based evaluation. Chest. 2006;130(5): 1301-1311. doi: 10.1378/chest.130.5.1301.
  13. Maltais F, Ostinelli J, Bourbeau J et al. Comparison of nebulized budesonide and oral prednisolone with placebo in the treatment of acute exacerbations of chronic obstructive pulmonary disease: a randomized controlled trial. Am J Respir Crit Care Med. 2002;165(5):698-703. doi: 10.1164/ajrccm.165.5.2109093.
  14. Авдеев С.Н., Суточникова О.А., Белевский А.С., Чучалин А.Г. Небулизированный будесонид (суспензия Пульмикорта) при тяжелом обострении ХОБЛ. Пульмонология. 2003;5:81-88.
  15. Gunen H, Hacievliyagil SS, Yetkin O, Gulbas G,Mutlu GL, In E. The role of nebulised budesonide in the treatment of exacerbations of COPD. Eur Respir J. 2007;29(4):660-667. doi: 10.1183/09031936.00073506.
  16. Yilmazel Ucar E, Araz O, Meral M, Sonkaya E, Saglam L, Kaynar H, Gorguner AM, Akgun M. Two different dosages of nebulized steroid versus parenteral steroid in the management of COPD exacerbations: A randomized control trial. Med Sci Monit. 2014;20:513-520. doi: 10.12659/msm.890210.
  17. Sun X, He Z, Zhang J et al. Compare the efficacy of inhaled budesonide and systemic methylprednisolone on systemic inflammation of AECOPD. Pulmon Pharmacol Ther. 2015;31:111-116. doi: 10.1016/j.pupt.2014.09.004.
  18. Garnacho-Montero J, Olaechea P, Alvarez-Lerma F, Alvarez-Rocha L, Blanquer J, Galván B, Rodriguez A, Zaragoza R, Aguado JM, Mensa J, Solé A, Barberán J. Epidemiology, diagnosis and treatment of fungal respiratory infections in the critically ill patient. Rev Esp Quimioter. 2013;26(2):173-188.
  19. Vogelmeier C. Systemic steroids in COPD-the beauty and the beast. Respir Res. 2014;15(1):38. doi: 10.1186/1465-9921-15-38.
  20. Kiser TH, Allen RR, Valuck RJ, Moss M, Vandivier RW. Outcomes associated with corticosteroid dosage in critically ill patients with acute exacerbations of chronic obstructive pulmonary disease. Am JRespir Crit Care Med. 2014;189(9):1052-1064. doi: 10.1164/rccm.201401-0058oc.
  21. Walters JA, Tan DJ, White CJ, Gibson PG, Wood-Baker R, Walters EH. Systemic corticosteroids for acute exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2014;9:CD001288. doi:0.1002/14651858.cd001288.pub4.
  22. Barnes P. Corticosteroid resistance in patients with asthma and chronic obstructive pulmonary disease. J Allergy Clin Immunol. 2013;131(3):636-645. doi: 10.1016/j.jaci.2012.12.1564.
  23. Митюшова Е.В. Роль интерлейкина-2 и JAK/STAT сигнализации в экспрессии рецептора интерлейкина-2 в лимфоцитах человека: Дис. .. канд. биол. наук. СПб; 2013.
  24. Sahid El-Radhi A, Hogg CL, Bungre JK, Bush A, Corrigan CJ. Effect of oral glucocorticoid treatment on serum inflammatory markers in acute asthma. Arch Dis Child. 2000;83(2):158-162.
  25. Любавина Н.А., Варварина Г.Н., Макарова Е.В., Меньков Н.В., Преснякова Н.Б., Караулов А.В., Новиков В.В. Влияние стандартной патогенетической терапии на сывороточный уровень молекул sCD38, sCD25 и sCD95 у больных бронхиальной астмой смешанного типа. Иммунология. 2011;5:267-269.
  26. Blidberg K, Palmberg L, James A et al. Adhesion molecules in subjects with COPD and healthy non-smokers: a cross sectional parallel group study. Respir Res. 2013;14(1):47. doi: 10.1186/1465-9921-14-47.
  27. Orciani M, Trubiani O, Guarnieri S, Ferrero E, Di Primio R. CD38 is constitutively expressed in the nucleus of human hematopoietic cells. J Cell Biochem. 2008;105(3):905-912. doi: 10.1002/jcb.21887.
  28. Gorska-Ciebiada M, Ciebiada M, Gorska M, Gorski P, Grzelewska-Rzymowska I. Intercellular adhesion molecule 1 and tumor necrosis factor α in asthma and persistent allergic rhinitis: relationship with disease severity. Ann Allergy, Asthma Immunol. 2006;97(1):66-72. doi: 10.1016/s1081-1206(10)61372-5.
  29. Tirumurugaan K, Kang B, Panettieri R, Foster D, Walseth T, Kannan M. Regulation of the cd38 promoter in human airway smooth muscle cells by TNF-α and dexamethasone. Respir Res. 2008;9(1):26. doi: 10.1186/1465-9921-9-26.
  30. Pang B, Hong W, West-Barnette SL, Kock ND, Swords WE. Diminished ICAM-1 expression and impaired pulmonary clearance of nontypeable Haemophilus influenzae in a mouse model of chronic obstructive pulmonary disease/emphysema. Infect Immun. 2008;76(11):4959-4967. doi: 10.1128/iai.00664-08.
  31. Любавина Н.А., Макарова Е.В., Меньков Н.В., Майорова Л.В., Шония М.Л., Преснякова Н.Б., Королева В.В., Варварина Г.Н., Новиков В.В. Особенности клинического течения хронической обструктивной болезни легких в зависимости от продолжительности курения и состояния иммунного ответа пациентов. Пульмонология. 2013;4:52-55.
  32. Oddera S, Silvestri M, Lantero S, Sacco O, Rossi G. Downregulation of the Expression of Intercellular Adhesion Molecule (ICAM)-1 on Bronchial Epithelial Cells by Fenoterol, a β2-Adrenoceptor Agonist. J Asthma. 1998;35(5):401-408. doi: 10.3109/02770909809048948.
  33. Kanoh S, Rubin B. Mechanisms of Action and Clinical Application of Macrolides as Immunomodulatory Medications. Clin Microbiol Rev. 2010;23(3):590-615. doi: 10.1128/cmr.00078-09.
  34. Yamaya M, Nishimura H, Hatachi Y et al. Inhibitory effects of tiotropium on rhinovirus infection in human airway epithelial cells. Eur Respir J. 2012;40(1):122-132. doi: 10.1183/09031936.00065111.
  35. Yamaya M, Nishimura H, Nadine LK, Ota C, Kubo H, Nagatomi R. Ambroxol inhibits rhinovirus infection in primary cultures of human tracheal epithelial cells. Arch Pharm Res. 2014;37(4):520-529. doi: 10.1007/s12272-013-0210-7.
  36. Singh S, Loke Y. Risk of pneumonia associated with long-term use of inhaled corticosteroids in chronic obstructive pulmonary disease: a critical review and update. Cur Opin Pulmon Med. 2010;16(2):118-122. doi: 10.1097/mcp.0b013e328334c085.
  37. Kew KM, Seniukovich A. Inhaled steroids and risk of pneumonia for chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2014;3:CD010115. doi: 10.1002/14651858. cd010115.pub2.

Statistics

Views

Abstract: 164

PDF (Russian): 68

Article Metrics

Metrics Loading ...

Refbacks

  • There are currently no refbacks.

Copyright (c) 2016 Makarova E.V., Varvarina G.N., Menkov N.V., Czapaeva M.Y., Lazareva E.S., Kazatskaya Z.A., Novikov V.V., Karaulov A.V.

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
 

Address of the Editorial Office:

  • Novij Zykovskij proezd, 3, 40, Moscow, 125167

Correspondence address:

  • Novoslobodskaya str 31c4., Moscow, 127005, Russian Federation

Managing Editor:

 

© 2018-2021 "Consilium Medicum" Publishing house


This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies