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Effect of an inhaled glucocorticoid on endothelial function in healthy smokers

¹Division of Pulmonary and Critical Care Medicine, Department of Medicine, Miller School of Medicine, University of Miami, Miami, Florida; and ²Department of Respiratory Medicine, Semmelweis University School of Medicine, Budapest, Hungary

Submitted 27 February 2008 ; accepted in final form 1 May 2008

Cigarette smoking is associated with attenuated endothelium-dependent vasodilation (endothelial dysfunction) in the systemic circulation, including the airway circulation. We wished to determine whether an inhaled corticosteroid could restore endothelial function in the airway of lung-healthy current smokers, ex-smokers, and nonsmokers. We measured baseline airway blood flow (aw) and aw reactivity to inhaled albuterol as an index of endothelium-dependent vasodilation and to sublingual nitroglycerin as an index of endothelium-independent vasodilation in lung-healthy current smokers, ex-smokers, and nonsmokers. Current smokers were then treated with inhaled fluticasone for 3 wk, and all measurements were repeated after fluticasone treatment and after a subsequent 3-wk fluticasone washout period. Baseline mean aw and endothelium-independent aw reactivity were similar in the three groups. Mean endothelium-dependent aw reactivity was 49.5% in nonsmokers, 42.7% in ex-smokers, and 10.8% in current smokers (P < 0.05 vs. nonsmokers). In current smokers, mean baseline aw was unchanged after fluticasone treatment, but endothelium-dependent aw reactivity significantly increased to 34.9%. aw reactivity was again blunted after fluticasone washout. Endothelial dysfunction, as assessed by vascular reactivity, can be corrected with an inhaled corticosteroid in the airway of lung-healthy current smokers. This proof of concept can serve as the basis for future clinical investigations on the effect of glucocorticoids on endothelial function in smokers.

airway blood flow; smoking