LATE-BREAKING ABSTRACT: Long-term effects of inhaled corticosteroids on sputum bacterial and viral loads in COPD patients

Rationale: The use of inhaled corticosteroid (ICS) in COPD reduces the risk of exacerbations but it is associated with increased risk of pneumonia Aims and objectives: We compared the effects of 1-year treatment with either Fluticasone propionate/Salmeterol (SALM/FP) or Salmeterol (SALM) alone on sputum bacterial and viral loads in moderate COPD patients Methods: 60 stable moderate COPD patients were recruited and randomized to receive either SALM/FP 50/500 mcg bid or SALM 50 mcg bid for 12 months. After baseline assessment, patients were seen every 3 months. At each visit lung function was assessed and induced sputum collected to evaluate the inflammatory cell profile and quantitative/qualitative bacteriology/virology Results: After 1-year treatment, sputum total bacterial load significantly increased in the SALM/FP group (Δ +1.3[-3 – 5] Log 10 CFU/ml, p 10 CFU/ml, pu003e0.05). A non-significant increase of potentially pathogen bacterial load was observed in sputum samples of SALM/FP treated patients. No difference in respiratory virus detection rate was observed between the two arms. The increase in airway total bacterial load did not correlate with any of the clinical outcomes assessed during the study. Among SALM/FP treated patients, the increase in total bacterial load occurred in those subjects with no sputum eosinophil detection throughout the study (p=ns) Conclusions: In moderate COPD patients ICS-treatment is associated with a significant increase in airway total bacterial load, not related to clinical outcomes, when eosinophils are persistently absent in sputum samples The study was supported by unrestricted grant from GlaxoSmithKline.