Inhaled salmeterol and albuterol in asthmatic patients receiving high-dose inhaled corticosteroids.
Salmeterol may be useful in the treatment of asthmatic patients requiring high-dose inhaled steroids, and there have been debates about its anti-inflammatory action. We have compared the efficacy and effects on serum inflammatory markers, including soluble interleukin 2R (sIL-2R), eosinophil cationic protein (ECP), and tryptase of salmeterol and albuterol in 20 patients with moderate to severe asthma who were all receiving high-dose inhaled corticosteroids and inhaled beta 2-agonist on demand. After a 2-week run-in period, they received, in a randomized, crossover, double-blind and placebo-controlled manner, either salmeterol, 50 micrograms twice a day, or albuterol 400 micrograms, four times a day, from a powder inhaler during two 2-week treatment periods, separated by a 2-week washout. Compared with albuterol, salmeterol treatment was associated with better morning and mean peak expiratory flow (p = 0.013 and 0.016, respectively), less daytime and nocturnal symptoms (p = 0.008 and 0.01, respectively), reduced requirement of rescue albuterol (p = 0.04), and better efficacy rating by patients (p = 0.04). However, serum concentration of sIL-2R was significantly higher during regular albuterol treatment (p = 0.014) but no differences were seen in the concentrations of ECP and tryptase between the two treatment periods. We conclude that inhaled salmeterol, 50 micrograms twice daily, confers a better control of asthma than albuterol, 400 micrograms four times daily, in patients with moderate to severe disease, and the latter treatment may be associated with increased T-lymphocyte activation.
Lai
C K
CK
Department of Medicine, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin.
Chan
C H
CH
Ho
S S
SS
Hui
A C
AC
Lai
K N
KN
D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000318:Adrenergic beta-Agonists / Q000008:administration & dosage / Q000627:therapeutic use*; D000420:Albuterol / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D001249:Asthma / Q000097:blood / Q000188:drug therapy*; D018592:Cross-Over Studies; D004311:Double-Blind Method; D005541:Forced Expiratory Volume; D006801:Humans; D010366:Peak Expiratory Flow Rate; D011239:Prednisolone / Q000627:therapeutic use; D015375:Receptors, Interleukin-2 / Q000032:analysis; D000068299:Salmeterol Xinafoate; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones; D000318:Adrenergic beta-Agonists; D015375:Receptors, Interleukin-2; D000068299:Salmeterol Xinafoate; D011239:Prednisolone; D000420:Albuterol