title: Salmeterol decreases eosinophilic cationic protein and rescue medication in patients inhaling beclomethasone dipropionate: preliminary study in mild and moderate asthma in Trinidad, West Indies.
abstract: Activated eosinophils play a critical role in asthma pathogenesis, and eosinophil cationic protein (ECP) is a useful indicator of inflammation. Inhaled corticosteroids and long-acting beta2-agonists (LABA) effectively control asthma symptoms and improve airway function. Salmeterol's anti-inflammatory efficacy as add-on therapy to inhaled corticosteroids has not been evaluated in Caribbean populations. We investigated nine non-smoking subjects (three men and six women; mean age: +/- SE, 50.7 +/- 3.82 years) with stable mild and moderate persistent asthma who were inhaling > or = 500 microg beclomethasone dipropionate (BDP) daily. This was a with-in-patient controlled laboratory blind study performed over 8 weeks. Patients received BDP for 2 weeks, add-on salmeterol 100 microg in weeks 3-6 and BDP alone in weeks 7-8. Patients recorded daily morning and night symptoms. Morning peak expiratory flow rate was measured on entry to the study and with sputum ECP at the end of weeks 2, 4, 6 and 8. Salmeterol together with BDP decreased sputum ECP from a pretreatment median value of 897.84 microg/l to 628.38 microg/l after 4 weeks, and ECP continued to decrease even after salmeterol withdrawal. Both drugs decreased the frequency of rescue medication use by approximately 50% and increased the median number of days per week without rescue salbutamol from 0 to 3 days. Salmeterol's bronchoprotective effect was maximal after 4 weeks and was sustained after its withdrawal. In conclusion, this study, performed in Trinidadian asthmatics, used ECP as a surrogate marker of bronchial inflammation and supports the recent Salmeterol Multi-center Asthma Research Trial (SMART) data recommending add-on salmeterol therapy to adequate anti-inflammatory medication such as inhaled corticosteroids for optimal asthma management. Further studies are required to evaluate the anti-inflammatory efficacy and possible tolerance to salmeterol in Caribbean patients.
authors.affiliation: Department of Paraclinical Sciences, Faculty of Medical Sciences, The University of the West Indies, Trinidad, West Indies.
authors.forename: L M
authors.initials: LM
authors.lastname: Pinto Pereira
authors.forename: Y
authors.initials: Y
authors.lastname: Clement
authors.forename: J
authors.initials: J
authors.lastname: Rouse
authors.forename: J
authors.initials: J
authors.lastname: Matthew
authors.forename: Z
authors.initials: Z
authors.lastname: Asgarali
authors.forename: D
authors.initials: D
authors.lastname: Ramoutar
authors.forename: S
authors.initials: S
authors.lastname: Teelucksingh
mesh_terms: D000280:Administration, Inhalation; D000318:Adrenergic beta-Agonists / Q000494:pharmacology / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000420:Albuterol / Q000031:analogs & derivatives* / Q000494:pharmacology / Q000627:therapeutic use*; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy*; D001507:Beclomethasone / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood; D001798:Blood Proteins; D047091:Eosinophil Granule Proteins; D004804:Eosinophils / Q000187:drug effects / Q000378:metabolism; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D012260:Ribonucleases / Q000097:blood*; D000068299:Salmeterol Xinafoate; D016896:Treatment Outcome; D014300:Trinidad and Tobago
chemical_list: D000318:Adrenergic beta-Agonists; D000893:Anti-Inflammatory Agents; D015415:Biomarkers; D001798:Blood Proteins; D047091:Eosinophil Granule Proteins; D000068299:Salmeterol Xinafoate; D012260:Ribonucleases; D001507:Beclomethasone; D000420:Albuterol