Comparison of respiratory parameters and plasma cytokine levels between treatment with salmeterol/fluticasone and ipratropium/terbutaline/budesonide in mechanically ventilated COPD patients

Background: It is unknown whether the bronchodilation and anti-inflammatory effects of inhaled salmeterol and fluticasone (SF) are better than those of traditionally inhaled ipratropium, terbutaline and budesonide (ITB) in mechanically ventilated patients with chronic obstructive pulmonary disease (COPD). Methods: Nineteen stable COPD patients with respiratory failure were randomly enrolled into two groups. Patients were treated with inhaled SF delivered by a metered-dose inhaler with a spacer or with inhaled nebulized ITB. Respiratory parameters were measured for 7 days and plasma cytokine levels were measured on days 1 and 7. Results: The kinetic curve of the rapid shallow index (RSI) from day 1 to day 7 was significant lower in the SF group than that in the ITB group. There were no significant differences in minute ventilation, intrinsic positive end expiratory pressure, and airway resistance between the ITB and SF groups from day 1 to day 7. There were no differences in plasma interleukin (IL)-6, IL-10, IL-12, and transforming growth factor-beta1 levels between day 1 and day 7 in the ITB or SF group. Conclusions: Patients with inhaled SF treatment had a lower RSI. The effects of bron-chodilators and anti-inflammation were similar between inhaled SF and ITB in COPD patients with ventilator support.