title: Salmeterol improves fluid clearance from alveolar-capillary membrane in COPD patients: a pilot study.
abstract: The cardiovascular component associated with chronic obstructive pulmonary disease (COPD) plays a major role in disease prognosis, accounting for 25% of the deaths. Experimental and initial clinical data suggest that beta-adrenergic agonists accelerate fluid clearance from the alveolar airspace, with potentially positive effects on cardiogenic and noncardiogenic pulmonary oedema. This pilot study investigated the acute effects of the long-acting beta-2 agonist, salmeterol, on alveolar fluid clearance after rapid saline intravenous infusion by evaluating diffusive and mechanical lung properties. Ten COPD and 10 healthy subjects were treated with salmeterol or placebo 4 h before the patient's mechanical and diffusive lung properties were measured during four non consecutive days, just before and after a rapid saline infusion, or during a similar period without an infusion.
  
  
  RESULTS
  In both COPD and healthy subjects, rapid saline infusion with placebo or salmeterol premedication lead to a significant decrease in diffusion capacity for carbon monoxide (DLCO) and forced expiratory volume in 1 s (FEV1). Nonetheless, salmeterol pretreatment lead to a significantly reduced gas exchange impairment caused by saline infusion (-64% of DLCO reduction compared with placebo), whereas it did not affect changes in FEV1. In the control setting with no infusion, we found no significant change in either DLCO or mechanical properties of the lung.
  
  
  CONCLUSIONS
  Salmeterol appears to provide a protective effect, not related to bronchodilation, against an acute alveolar fluid clearance challenge secondary to lung fluid overload in COPD patients.
authors.affiliation: Respiratory Medicine Section, Dipartimento Toraco-Polmonare e Cardiocircolatorio, Università degli Studi di Milano, Ospedale San Paolo, Via Antonio Di Rudini 8, 20142 Milan, Italy. fabiano.dimarco@unimi.it
authors.forename: Fabiano
authors.initials: F
authors.lastname: Di Marco
authors.forename: Marco
authors.initials: M
authors.lastname: Guazzi
authors.forename: Giuseppe Francesco
authors.initials: GF
authors.lastname: Sferrazza Papa
authors.forename: Marco
authors.initials: M
authors.lastname: Vicenzi
authors.forename: Pierachille
authors.initials: P
authors.lastname: Santus
authors.forename: Paolo
authors.initials: P
authors.lastname: Busatto
authors.forename: Federico
authors.initials: F
authors.lastname: Piffer
authors.forename: Francesco
authors.initials: F
authors.lastname: Blasi
authors.forename: Stefano
authors.initials: S
authors.lastname: Centanni
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000420:Albuterol / Q000031:analogs & derivatives* / Q000627:therapeutic use; D001826:Body Fluids / Q000378:metabolism; D001993:Bronchodilator Agents / Q000627:therapeutic use*; D002196:Capillaries / Q000378:metabolism / Q000503:physiopathology*; D002248:Carbon Monoxide / Q000378:metabolism; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008566:Membranes / Q000187:drug effects / Q000502:physiology; D008875:Middle Aged; D010865:Pilot Projects; D011650:Pulmonary Alveoli / Q000378:metabolism / Q000503:physiopathology*; D011653:Pulmonary Diffusing Capacity / Q000187:drug effects; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy* / Q000503:physiopathology; D011659:Pulmonary Gas Exchange; D012129:Respiratory Function Tests; D015656:Respiratory Mechanics / Q000187:drug effects; D000068299:Salmeterol Xinafoate
chemical_list: D001993:Bronchodilator Agents; D000068299:Salmeterol Xinafoate; D002248:Carbon Monoxide; D000420:Albuterol