Der Effekt von inhaliertem HFA-134a Beclometasondipropionat (Ventolair) auf Lymphozyten der Bronchoalveolären Lavage (BAL) bei chronischer Sarkoidose

Abstract

Bei Patienten mit chronischer Lungensarkoidose wurde der Lymphozytenanteil in der bronchoalveolären Lavage als ein Marker für den inflammatorischen Status in der Lungenperipherie genutzt und dessen Veränderung nach 6 Monatiger Therapie mit 800µg Beclometason-17,21-dipropionat, das in Hydrofluoralkan 134a gelöst ist, untersucht.

Patients with pulmonary sarcoidosis can benefit from inhaled corticosteroids. In this study we assessed the effect of beclomethasone dipropionate (BDP), administered as extrafine, HFA(hydrofluoroalkane)-driven aerosol with high peripheral deposition, on bronchoalveolar lavage (BAL) lymphocyte numbers, as a marker of the disease. METHODS: Fifteen patients with newly-diagnosed pulmonary sarcoidosis (Stages I-III) received either BDP 800 microg daily (n = 6) or placebo (n = 9) for 6 months in a parallel-group design. Before and after treatment, clinical and radiological states were assessed, bronchoalveolar lavage (BAL) performed, and the cellular composition of BAL fluid as well as cytokine production by BAL lymphocytes determined. RESULTS: BDP caused a decrease in the percentage of BAL lymphocytes in the BDP (p < 0.05) but not the placebo group. HLA-DR expression on lymphocytes was diminished after BDP (p < 0.05), while intracellular cytokine production by lymphocytes was not altered. Chest radiography suggested an improvement in the BDP group. There was also a rise (p < 0.05) in the diffusing capacity for carbon monoxide. CONCLUSIONS: Though based on a small group of patients, the present findings suggest that in patients with pulmonary sarcoidosis of stage II and minor functional impairment, inhalation of high doses of BDP as extrafine, peripherally deposited aerosol is associated with a reduction in the number of BAL lymphocytes, in parallel with improvements in other markers of the disease.