Background With long-term administration of salmeterol, theextent of protection afforded by the drug against experimentalprecipitants of asthma such as methacholine and adenosine maydecrease. Whether this effect extends to a clinically relevantstimulus such as exercise is unknown.
Methods We performed a random-order, double-blind, crossovertrial in 20 patients with exercise-induced asthma. Each patientreceived inhaled salmeterol or placebo twice daily for a month,with a one-week washout period between treatments. The patientsperformed cycle ergometry while breathing frigid air 30 minutesafter the morning dose and 9 hours later on the 1st, 14th, and29th study days. The primary end point was the extent of thedecrease in forced expiratory volume in 1 second (FEV1) 10 minutesafter exertion.
Results With placebo, significant airway narrowing developedat all times (mean [±SE] decrease from base line in FEV1,19±2 percent in the morning and 18±2 percent inthe evening). The morning dose of salmeterol attenuated thedegree of bronchoconstriction at all times (decrease in FEV1on day 1, 5±2 percent; on day 14, 10±3 percent;and on day 29, 9±3 percent; P=0.10). Its ability to actthroughout the day, however, decreased with long-term administration(decrease in FEV1 from morning to evening on day 1, 6±2percent; on day 14, 15±3 percent; and on day 29, 14±3percent; P=0.003).
Conclusions Protection against exercise-induced asthma is maintainedwith long-term administration of salmeterol, but the lengthof time that the drug remains active after a single dose decreases.
Source Information
From the Division of Pulmonary and Critical Care Medicine, University Hospitals of Cleveland, and the Department of Medicine of Case Western Reserve University School of Medicine, Cleveland.
Address reprint requests to Dr. McFadden at the Division of Pulmonary and Critical Care Medicine, University Hospitals of Cleveland, 11100 Euclid Ave., Cleveland, OH 44106-5067.
Exercise-Induced Asthma
Aziz I., Lipworth B. J., Dickey B. F., Adachi R., Honig P. K., Jenkins J. K., Stempel D. A., McFadden E.R., Strauss L., Nelson J. A., Reiss T. F., Hansen-Flaschen J.
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N Engl J Med 1998;
339:1783-1786, Dec 10, 1998.
Correspondence
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