High levels of exhaled
nitric oxide (NO) predict favourable response to inhaled
corticosteroids in
asthma, but the ability of exhaled NO or inflammatory markers in exhaled breath condensate (EBC) to predict
steroid responsiveness in
chronic obstructive pulmonary disease (
COPD) is not known. We measured alveolar and bronchial NO output, levels of
leukotriene B(4) (LTB(4)), cysteinyl
leukotrienes (cysLTs) and
8-isoprostane in EBC, spirometry, body plethysmography and symptoms in 40 subjects with
COPD before and after 4 weeks of treatment with inhaled
fluticasone (500 microg b.i.d.). Five subjects (12.5%) with
COPD had significant improvement in lung function during
fluticasone treatment, whereas 20 subjects (50%) had significant decrease in symptoms. High baseline bronchial NO flux was associated with higher increase in forced expiratory volume in 1 s to forced vital capacity ratio (r = 0.334, p = 0.038) and more symptom relief (r = -0.317, p = 0.049) during the treatment. Baseline EBC levels of LTB(4), cysLTs or
8-isoprostane were not related to response to
fluticasone treatment. Inhaled
fluticasone decreased bronchial NO flux but not alveolar NO concentration or markers in EBC. High levels of bronchial NO flux are related to symptom relief and improvement of
airway obstruction during treatment with inhaled
fluticasone in
COPD. Markers of
inflammation or oxidative stress in EBC are not related to
steroid responsiveness in
COPD.