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BRONCHIECTASIS |
1 University Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong
2 Department of Microbiology, Queen Mary Hospital, The University of Hong Kong, Hong Kong
3 Department of Anatomy, Queen Mary Hospital, The University of Hong Kong, Hong Kong
Correspondence to:
Correspondence to:
Professor K W T Tsang
Department of Respiratory and Critical Care Medicine, University Department of Medicine, Queen Mary Hospital, Pokfulam Road, Hong Kong; kwttsang{at}hku.hk
Background: The clinical efficacy of inhaled corticosteroid (ICS) treatment has not been evaluated in bronchiectasis, despite the presence of chronic airway inflammation.
Methods: After three consecutive weekly visits, 86 patients were randomised to receive either fluticasone 500 µg twice daily (n = 43, 23F, mean (SD) age 57.7 (14.4) years) or matched placebo (n = 43, 34F, 59.2 (14.2) years) and reviewed regularly for 52 weeks in a double blind fashion.
Results: 35 and 38 patients in the fluticasone and placebo groups completed the study. Significantly more patients on ICS than on placebo showed improvement in 24 hour sputum volume (OR 2.5, 95% CI 1.1 to 6.0, p = 0.03) but not in exacerbation frequency, forced expiratory volume in 1 second, forced vital capacity, or sputum purulence score. Significantly more patients with Pseudomonas aeruginosa infection receiving fluticasone showed improvement in 24 hour sputum volume (OR 13.5, 95% CI 1.8 to 100.2, p = 0.03) and exacerbation frequency (OR 13.3, 95% CI 1.8 to 100.2, p = 0.01) than those given placebo. Logistic regression models revealed a significantly better response in sputum volume with fluticasone treatment than with placebo among subgroups of patients with 24 hour sputum volume <30 ml (p = 0.04), exacerbation frequency 
2/year (p = 0.04), and sputum purulence score >5 (p = 0.03).
Conclusions: ICS treatment is beneficial to patients with bronchiectasis, particularly those with P aerurginosa infection.
Keywords: bronchiectasis; fluticasone; inhaled corticosteroids
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