Effects of Inhaled Corticosteroids with Different Lung Deposition on Exhaled Hydrogen Peroxide in Stable COPD Patients

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Abstract
Background: The effects of inhaled corticosteroids (ICS) on markers of oxidative stress in patients with stable COPD are unclear. Objectives: The aim was to investigate the effect of ICS on exhaled H2O2 in stable COPD patients and to compare ICS with different lung deposition. Methods: Forty-one stable patients with moderate COPD (FEV1 ∼60% predicted) were randomized to sequence 1; first HFA-134a beclomethasone dipropionate (HFA-BDP, an ICS with more peripheral deposition) 400 µg b.i.d., then fluticasone propionate (FP, an ICS with more central deposition) 375 µg b.i.d. (n = 20) or sequence 2 ; first FP, then HFA-BDP (n = 21). Both 4-week treatment periods were preceded by a 4-week washout period. After each period, the concentration of H2O2 in exhaled breath condensate was measured. Results: The H2O2 concentration decreased significantly after the first treatment period in both sequence 1 and 2 (p < 0.05, p = 0.01, respectively). In neither sequence was there a return to baseline values after the second washout, indicating a carry-over effect. The concentrations remained low in both sequences during the second treatment period. Conclusions: Both ICS appeared to reduce exhaled H2O2 in stable COPD patients. However, this study showed no difference between ICS with different deposition patterns, which in part may be due to the carry-over effect.