[Treatment of chronic obstructive pulmonary disease with inhaled pharmacotherapy: role of corticosteroids].

Cigarette smoke-induced airway inflammation plays a central role in the pathophysiology of chronic obstructive pulmonary disease (COPD). It causes bronchial epithelial cell injury, which in turn initiates the recruitment of inflammatory cells and increases the production of cytokines, chemokines, proteases and other proinflammatory mediators followed by oxidative stress and protease/anti-protease imbalance impairing lung parenchymal elastic structures. Inhaled corticosteroids in combination with long-acting bronchodilators are generally recommended for the treatment of COPD. However, steroid responsiveness of patients with COPD is often poor, since oxidative stress may reduce the activity and expression of histone deacetylases, and therefore interfere with the anti-inflammatory action of corticosteroids. Recently, a number of studies has indicated that presence of sputum eosinophilia and/or elevated exhaled nitric oxide (NO) level may predict a better response to corticosteroid treatment in COPD patients. While sputum processing and its profiling is a time-consuming and technically demanding method, exhaled NO measurement is a simple and completely non-invasive tool, thus, the later could be more convenient for routine clinical use in the future.