COMPREHENSIVE ASSESSMENT OF ICS
Pratheesh Xavier P.*, Melwinraj A., Naveena B., Narmatha M. and Thirupathy Kumaresan P.
Chronic obstructive pulmonary disease is a progressive inflammatory disease of the lung characterized by chronic bronchitis, airway thickening and emphysema. Pulmonary inflammation is prominent in chronic obstructive pulmonary disease and corticosteroids are generally used in controlling the inflammation. The inflammation in chronic obstructive pulmonary disease is dominated by neutrophilic infiltration, with an increased numbers of macrophages and CD8 T lymphocytes; neutrophilic infiltration is not as responsive to steroids as the eosinophilic inflammation seen in asthma. Current guidelines highlight the fact that for chronic obstructive pulmonary disease patients uncontrolled by bronchodilator monotherapy, the use of a combination therapy is recommended. The combination of long acting beta agonists and inhaled corticosteroids is the most common in use for both chronic obstructive pulmonary disease and asthma. Inhaled corticosteroids and long acting beta agonists combination products have been shown to improve lung function, symptoms, and health status, and they reduce exacerbations in patients with moderate to severe chronic obstructive pulmonary disease . A more recently published retrospective analysis of veterans treated with tiotropium revealed that inhaled corticosteroids and long acting beta agonists and long acting muscarinic antagonists therapy was associated with a 40% reduction in mortality compared with treatment with inhaled corticosteroids plus long acting beta agonists. The adverse effects from the use of inhaled corticosteroids in patients with Chronic obstructive pulmonary disease, most notably severe pneumonia results in excess deaths.
Keywords: Glucocorticoid receptor; Nuclear factor-?B; Inflammatory gene; Histone deacetylase; Eosinophil, Epithelial cell; Inhaled corticosteroids; Inflammation; Pneumonia.
[Full Text Article]