Adding salmeterol to an inhaled corticosteroid reduces allergen-induced serum IL-5 and peripheral blood eosinophils.
BACKGROUND
Adding a long-acting beta(2)-agonist to inhaled corticosteroids results in better symptomatic asthma control than increasing the dose of inhaled corticosteroids.


OBJECTIVE
Investigating whether adding the long-acting beta(2)-agonist salmeterol to the inhaled corticosteroid fluticasone propionate has an effect on allergen-induced allergic inflammation in asthma.


METHODS
Bronchial allergen challenges were performed in 26 patients with allergic asthma, pretreating them with a single dose of either fluticasone/salmeterol (100/50 microg) or fluticasone alone (100 microg), in a double-blind, randomized, cross-over design. Sputum and serum markers of bronchial inflammation were measured after allergen challenge, as well as lung function parameters. Primary outcomes were sputum eosinophil numbers and eosinophil cationic protein.


RESULTS
Asthmatic responses after allergen challenge were significantly reduced after pretreatment with fluticasone/salmeterol relative to fluticasone alone. Sputum inflammatory markers after allergen challenge were not significantly affected by fluticasone/salmeterol pretreatment. By contrast, serum IL-5 was significantly reduced (geometric mean serum IL-5 [SEM]: 0.5 [0.3] vs 1.1 [0.3] pg/mL 1 hour and 0.6 [0.3] vs 1.1 [0.3] pg/mL 6 hours after challenge with fluticasone/salmeterol vs fluticasone alone pretreatment, respectively; P values < .05). Also, peripheral blood eosinophils were significantly reduced (geometric mean number x 10(6)/L [SEM]: 172 [0.1] vs 237 [0.1] at 6 hours and 271 [0.1] vs 351 [0.1] at 24 hours with fluticasone/salmeterol vs fluticasone alone pretreatment, respectively; P < .05).


CONCLUSIONS
Adding salmeterol to fluticasone reduces allergen-induced serum IL-5 and peripheral blood eosinophils. This phenomenon may contribute to the improved clinical outcomes that result from adding a long-acting beta(2)-agonist to inhaled corticosteroids.
Koopmans
Julia G
JG
Department of Pulmonology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Lutter
René
R
Jansen
Henk M
HM
van der Zee
Jaring S
JS
D000280:Administration, Inhalation; D000420:Albuterol / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000485:Allergens / Q000276:immunology*; D000730:Androstadienes / Q000008:administration & dosage* / Q000627:therapeutic use; D001249:Asthma / Q000188:drug therapy* / Q000209:etiology; D001993:Bronchodilator Agents / Q000627:therapeutic use*; D018592:Cross-Over Studies; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D004804:Eosinophils / Q000473:pathology*; D000068298:Fluticasone; D006801:Humans; D006967:Hypersensitivity / Q000097:blood / Q000150:complications*; D015848:Interleukin-5 / Q000097:blood*; D007958:Leukocyte Count; D000068299:Salmeterol Xinafoate; D013997:Time Factors
D000485:Allergens; D000730:Androstadienes; D001993:Bronchodilator Agents; D015848:Interleukin-5; D000068299:Salmeterol Xinafoate; D000068298:Fluticasone; D000420:Albuterol