Effect of inhaled indomethacin in asthmatic patients taking high doses of inhaled corticosteroids.
BACKGROUND
Cyclooxygenase products of arachidonic acid may play a part in bronchoconstriction and airway inflammation in asthma.


OBJECTIVE
We sought to determine the effect of inhaled indomethacin on asthma control and asthma exacerbations during reduction of inhaled corticosteroids in patients with moderate-to-severe steroid-dependent asthma.


METHODS
We conducted a double-blind, randomized, parallel-group, multicenter study in 38 patients with asthma taking high doses (> or =1500 microg/d) of beclomethasone dipropionate (BDP). After a run-in period, patients were assigned inhaled indomethacin (50 mg/d) or placebo for 6 weeks, during which the daily doses of BDP were reduced to half at week 2 and then to one third of the baseline dose at week 4.


RESULTS
Data were available from 34 patients. After the reduction of BDP doses, FEV(1), peak expiratory flow, asthma symptoms, and exhaled nitric oxide concentrations deteriorated in both treatment groups, but these effects were less pronounced in the indomethacin group compared with the placebo group. During the 6-week treatment period, 89% of the patients receiving placebo had relapse of asthma, whereas only 38% of those receiving inhaled indomethacin did so (P =.003).


CONCLUSIONS
Inhalation of indomethacin can reduce asthma exacerbations induced by reduction of high-dose inhaled corticosteroid in steroid-dependent asthma.
Tamaoki
J
J
First Department of Medicine, Tokyo Women's Medical University School of Medicine, Japan.
Nakata
J
J
Nishimura
K
K
Kondo
M
M
Aoshiba
K
K
Kawatani
K
K
Nagai
A
A
D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000627:therapeutic use*; D000328:Adult; D001249:Asthma / Q000188:drug therapy*; D001507:Beclomethasone / Q000008:administration & dosage / Q000627:therapeutic use; D004311:Double-Blind Method; D005260:Female; D005541:Forced Expiratory Volume; D005938:Glucocorticoids / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D007213:Indomethacin / Q000008:administration & dosage / Q000494:pharmacology*; D008297:Male; D008875:Middle Aged; D009569:Nitric Oxide / Q000378:metabolism; D010919:Placebos; D012129:Respiratory Function Tests
D000305:Adrenal Cortex Hormones; D005938:Glucocorticoids; D010919:Placebos; D009569:Nitric Oxide; D001507:Beclomethasone; D007213:Indomethacin