Effects of Different Combined Bronchodilator Therapies on Airway Inflammation in COPD1

Correlation Between Tumor Necrosis Factor-α and Interleukin-1β in Exhaled Breath Condensate and Pulmonary Function

BACKGROUND

Exhaled breath condensate (EBC) has emerged as a noninvasive method for assessing inflammation in lung diseases. Our aim is to investigate the correlation between tumor necrosis factor α (TNF-α) and interleukin 1β (IL-1β) in EBC and in lung tissue, and between these values in EBC with pulmonary function tests in patients with chronic obstructive pulmonary disease (COPD).

MATERIALS AND METHODS

To ensure the availability of lung tissue, 60 patients undergoing resection for early lung cancer were divided into 3 groups: a COPD treatment group, a COPD control group and a non-COPD group. Patients in the COPD treatment group received what was termed "lung-protective treatment" including ambroxol, budesonide and ipratropium bromide in addition to chest physiotherapy. Patients underwent pulmonary function testing and EBC collection, and TNF-α and IL-1β were detected by enzyme-linked immunosorbent assay (ELISA). TNF-α and IL-1β in lung tissues were evaluated by immunoflorescense. Correlations were analyzed by Pearson correlation coefficients.

RESULTS

The TNF-α and IL-1β levels in EBC were significantly higher in the COPD groups compared with the non-COPD group before surgery (all P < 0.01), and the levels were significantly decreased after lung-protective treatment was received before surgery (all P < 0.01). TNF-α and IL-1β levels in EBC were significantly decreased in all patients after surgery with lung-protective treatment (P = 0.027, P = 0.004). TNF-α and IL-1β content in lung tissues was significantly higher in the COPD groups (all P < 0.05), and the histologic analysis showed similar results. Negative correlations between FEV1/FVC and expression of TNF-α and IL-1β were observed. There was a positive correlation between TNF-α and IL-1β in lung tissues and in EBC.

CONCLUSIONS

TNF-α and IL-1β in EBC are potential biomarkers for evaluating pulmonary function and inflammation in patients with COPD. Furthermore, lung-protective treatment is effective in reducing inflammation in patients with COPD.

The effect of pulse methylprednisolone plus theophylline treatment on clinical, pulmonary and inflammatory markers in relapses of multiple sclerosis

OBJECTIVE

The aim of this study was to evaluate whether there was a relationship between severity of multiple sclerosis (MS) exacerbation and pulmonary function test (PFT) and to determine the effect of theophylline, which was added to intravenous methylprednisolone, on serum Tumor Necrosis Factor (TNF)-alpha levels and clinical scores in MS relapses.

STUDY DESIGN

Double blind randomized controlled trial.

MATERIAL AND METHODS

The baseline Expanded Disability Status Scale (EDSS) score was determined, PFT was performed and blood was taken for analysis of TNF- alpha in patients with MS exacerbation. Patients were randomly divided into two groups; group 1 received intravenous methylprednisolone+IV theophylline and group 2 intravenous methylprednisolone+placebo for 5 days. PFT and EDSS score were repeated and blood was taken for TNF-alpha on the 5(th) and 30(th) days of the treatment.

RESULTS

Twenty-four patients (14 female, 10 male) were included in the study. Mean age was 32.6±9, duration of disease was 5.4±4.2 years, number of exacerbations was 5±2. There was a significant correlation between the number of exacerbations and EDSS score (p=0.000, r=1). Restrictive PFT findings were detected in 8 and decrease in carbon monoxide diffusing capacity (DLCO) in 3 cases. In within-group analysis, EDSS score was found to be decreased on day 5 and still low on day 30 in the theophylline group (baseline 3±1.3; 5(th) day 2.4±1.6; 30(th) day 2±1.7). There was no statistically significant difference in the EDSS score of the placebo group (3±1.6; 2.8±1.7; 2.4±1.9 respectively). While serum TNF-alpha level was not changed in the placebo group, there was a non-significant decrease on day 5 and increase on day 30 in the theophylline group. There was no correlation between the clinical parameters, PFT and TNF-alpha level.

CONCLUSION

There was no correlation between severity of MS and PFT findings. It is suggested that theophylline might be effective in MS exacerbations since it caused decreases in clinical scores; studies with longer treatment duration are needed to clarify its possible anti-inflammatory effect.