Adding salmeterol to an inhaled corticosteroid: long term effects on bronchial inflammation in asthma
| Autor: | René Lutter, Julia G. Koopmans, J. S. Van Der Zee, Henk M. Jansen |
|---|---|
| Přispěvatelé: | Amsterdam institute for Infection and Immunity, Pulmonology |
| Jazyk: | angličtina |
| Rok vydání: | 2006 |
| Předmět: |
Pulmonary and Respiratory Medicine
Adult Male medicine.medical_specialty Membrane permeability medicine.drug_class Anti-asthmatic Agent Gastroenterology Double-Blind Method immune system diseases Internal medicine Administration Inhalation medicine Humans Albuterol Anti-Asthmatic Agents Bronchitis Salmeterol Xinafoate Fluticasone Asthma Eosinophil cationic protein Analysis of Variance business.industry respiratory system Middle Aged medicine.disease respiratory tract diseases Bronchodilator Agents Androstadienes Drug Combinations Treatment Outcome Bronchial hyperresponsiveness Immunology Corticosteroid Female Salmeterol business medicine.drug |
| Zdroj: | Thorax, 61(4), 306-312. BMJ Publishing Group |
| ISSN: | 0040-6376 |
| Popis: | BACKGROUND: Addition of the long acting beta2 agonist salmeterol to inhaled corticosteroids leads to better symptomatic asthma control than increasing the dose of inhaled corticosteroids. However, little is known about the long term effects of adding salmeterol on the asthmatic inflammatory process, control of which is considered important for the long term outcome of asthma. METHODS: After a 4 week fluticasone run-in period, 54 patients with allergic asthma were randomised to receive twice daily treatment with fluticasone 250 microg with or without salmeterol 50 microg for 1 year in a double blind, parallel group design (total daily dose of fluticasone 500 microg in both treatment groups). Primary outcomes were sputum eosinophil numbers and eosinophil cationic protein concentrations. Secondary outcomes were neutrophil associated sputum parameters and a respiratory membrane permeability marker. The effects on allergen induced changes were determined before and at the end of the treatment period. RESULTS: Adding salmeterol to fluticasone resulted in improved peak expiratory flow, symptom scores, rescue medication usage, and bronchial hyperresponsiveness (p < 0.05 for all). There was no sustained effect on sputum cell differential counts and cytokine concentrations during the treatment period or on changes induced by allergen challenge at the end of treatment (p > 0.05). However, adding salmeterol significantly reduced sputum ratios of alpha2-macroglobulin and albumin during the treatment period (p = 0.001). CONCLUSIONS: The addition of salmeterol to fluticasone produces no sustained effect on allergen induced cellular bronchial inflammation but leads to a significant improvement in size selectivity of plasma protein permeation across the respiratory membrane. This may contribute to the improved clinical outcome seen in patients with allergic asthma when a long acting beta2 agonist is combined with inhaled corticosteroids |
| Databáze: | OpenAIRE |
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