Brian Lipworth, Rory Chan, Chris RuiWen Kuo
European Respiratory Journal 2020 56: 2002005; DOI: 10.1183/13993003.02005-2020
We read with interest the observations of Aliberti et al.  showing that blood eosinophilia predicts the quality of life response to inhaled fluticasone propionate (FP) in bronchiectasis, apparently independently of concomitant asthma or COPD. Pointedly they only appeared to have measured blood eosinophils at baseline and not during treatment with FP. This is pertinent as FP produces dose-dependent suppression of blood eosinophils due to systemic absorption from the lung. Hence, 1 mg of inhaled fluticasone in asthma patients is systemically equivalent to 5.3 mg of oral prednisolone for blood eosinophil suppression and 8.5 mg for cortisol suppression . We would therefore be interested to know if similar improvements in quality of life occur in bronchiectasis in relation to blood eosinophilia with other inhaled corticosteroids (ICS) that exhibit much less systemic glucocorticoid potency, such as budesonide or beclmomethasone . Also, it would be interesting to know if patients with bronchiectasis who have other elevated type-2 biomarkers, such as fractional exhaled nitric oxide, might also benefit from either inhaled FP or other ICS .
Fluticasone response in bronchiectasis may be explained by its systemic eosinophil suppression https://bit.ly/3dDd74E
Conflict of interest: B. Lipworth reports grants, personal fees for consultancy, advisory board work and lectures, and expenses for meeting attendance from AstraZeneca and Chiesi, grants and personal fees for consultancy, advisory board work and lectures from Teva, provision of equipment from GSK, during the conduct of the study; personal fees for consultancy from Lupin, Cipla, Vectura, Dr Reddys and Glenmark, personal fees for advisory board work from Novartis, grants and personal fees for consultancy from Sanofi, outside the submitted work; and has a family member employed by AstraZeneca.
Conflict of interest: R. Chan has nothing to disclose.
Conflict of interest: C.R.W. Kuo reports personal fees for meeting attendance from AstraZeneca, personal fees for lectures and meeting attendance from Chiesi, personal fees for advisory board work from Circassia, outside the submitted work.