Salmeterol resolves airway obstruction but does not possess anti-eosinophil efficacy in newly diagnosed asthma: a randomized, double-blind, parallel group biopsy study comparing the effects of salmeterol, fluticasone propionate, and disodium cromoglycate.
BACKGROUND
Salmeterol (SLM) is a long-acting beta(2)-receptor agonist that produces bronchodilatation for 12 hours in asthmatic subjects. The effects of the regular use of long-acting beta(2)-agonists on airway inflammation are largely unknown.


OBJECTIVE
We examined the effects of 16 weeks of treatment with 50 microg SLM bid, 250 microg fluticasone propionate (FP) bid,5 mg disodium cromoglycate (DSCG) qid, or placebo on airway inflammation in bronchial mucosa.


METHODS
Airway inflammation was assessed in bronchial biopsy specimens before and after treatments and bronchial hyperresponsiveness (BHR) in 80 patients with newly diagnosed asthma. Inflammatory cells and tenascin in the basement membrane were studied with immunohistochemical methods. Peak expiratory flow rate (PEF), symptoms, and need for rescue medication were recorded.


RESULTS
SLM, FP, and DSCG reduced symptoms and need for rescue medication (P <.04). Both SLM and FP improved PEF and increased PD15FEV(1) to histamine by 2.8 and 5.2 doubling dose units, respectively. Both compounds reduced BHR more than placebo (P <.05). Both SLM and placebo had no effect on any inflammatory cell type. In both FP-treated and DSCG-treated patients, the number of EG2-positive eosinophils in the airway mucosa decreased (P =.002 and P <.05, respectively).


CONCLUSIONS
SLM showed no anti-eosinophil properties in this study, but it provided good symptom control. FP provided the best anti-eosinophil properties and symptom relief of the studied compounds.
Lindqvist
Ari
A
Department of Medicine, Helsinki University Central Hospital, Finland.
Karjalainen
Eeva-Maija
EM
Laitinen
Lauri A
LA
Kava
Tuomo
T
Altraja
Alan
A
Pulkkinen
Markku
M
Halme
Maija
M
Laitinen
Annika
A
D000328:Adult; D000402:Airway Obstruction / Q000188:drug therapy*; D000420:Albuterol / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D000730:Androstadienes / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy* / Q000473:pathology / Q000503:physiopathology; D001706:Biopsy; D001980:Bronchi / Q000473:pathology; D004205:Cromolyn Sodium / Q000627:therapeutic use*; D004311:Double-Blind Method; D004804:Eosinophils / Q000187:drug effects* / Q000502:physiology; D005260:Female; D000068298:Fluticasone; D006801:Humans; D008168:Lung / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D000068299:Salmeterol Xinafoate
D000730:Androstadienes; D000068299:Salmeterol Xinafoate; D000068298:Fluticasone; D004205:Cromolyn Sodium; D000420:Albuterol