at least during a short period, the ICS did not affect the most
prominent aspect of airway inflammation commonly seen in
COPD. There was no real relationship with any clinical parameter.
Clearly, however, the finding of mast cell reduction deserves
further investigation. The same group has showed a 65% decrease
in the number of mucosal mast cells, using an electron
microscopic analysis (28). ICSs may affect “asthma-like airway
inflammation” in COPD, which might be more important in
relation to exacerbations than to other aspects of COPD. Investigation
of the so-called reversible component of airway inflammation
might lead to better long-term treatment of patients
with COPD. Small airways and lung parenchyma might play a
predominant role in COPD (29); the absence of any data regarding
the potential of ICS on those aspects of lung inflammation
deserves further investigations.