Effect of inhaled fluticasone with and without salmeterol on airway inflammation in asthma
Effect of inhaled fluticasone with and without salmeterol on airway inflammation in asthma
Background: The clinical benefit of combining long-acting ?2-agonists with inhaled corticosteroids rather than doubling the dose of corticosteroid has been well-documented. However, there are concerns that this might result in a masking of underlying airway inflammation.
Objective: The aim of this study was to test the hypothesis that the addition of the long-acting ?2-agonist salmeterol (SALM) to a low dose of the inhaled corticosteroid fluticasone propionate (FP) has a steroid-sparing effect and does not result in a worsening of bronchial inflammation compared to doubling the dose of inhaled corticosteroid.
Methods: Fifty-six asthmatic subjects, previously not well-controlled on inhaled corticosteroids, were randomized to receive 3 months of treatment with inhaled FP 500 ?g twice a day (FP 1000) or FP 200 ?g twice a day plus SALM 50 ?g twice a day (FP 400 + SALM). Fluticasone propionate 200 ?g twice a day served as the control (FP400). Bronchial mucosal biopsy specimens, bronchial washings (BW), and bronchoalveolar lavage were obtained before and after treatment. The primary end points for the study were submucosal mast cell and eosinophil counts.
Results: There was a significant improvement in FEV1 in the FP400 + SALM group compared to both the FP400 and FP1000 groups. This was accompanied by a significant improvement in peak expiratory flow in the FP400 + SALM group in both the morning and evening compared to the FP1000 group. There were no significant between treatment differences in the change in the number of submucosal mast cells or eosinophils. However, in the FP400 + SALM group there was a significant decrease in submucosal mast cells after 12 weeks of treatment. The addition of SALM to FP was not associated with any increases in airway inflammation in the biopsy specimens, bronchoalveolar lavage, or bronchial washings.
Conclusion: These findings confirm that addition of SALM to FP has clinical benefits but does not mask or exacerbate airway inflammation and suggest that long-acting ?2-adrenoceptor agonists might influence mast cell numbers.
72-78
Wallin, Annika
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Sue-Chu, Malcolm
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Bjermer, Leif
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Ward, Jonathan
a8107b98-069d-4263-bd70-d29d79f07edc
Sandström, Thomas
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Lindberg, Anne
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Lundbäck, Bo
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Djukanovic, Ratka
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Holgate, Stephen
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Wilson, Susan
21c6875d-6870-441b-ae7a-603562a646b8
July 2003
Wallin, Annika
113ea341-ee86-42ed-9afc-8a60d75e8924
Sue-Chu, Malcolm
ba594f4d-f122-4420-bae2-9bcafb65d8c5
Bjermer, Leif
b1880328-5814-4334-b922-4ed3332b7bae
Ward, Jonathan
a8107b98-069d-4263-bd70-d29d79f07edc
Sandström, Thomas
77a4c11d-a84f-4a52-9bfe-4ec83f62363a
Lindberg, Anne
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Lundbäck, Bo
eb226874-21a7-4d1f-bd27-a29d83eabb02
Djukanovic, Ratka
d9a45ee7-6a80-4d84-a0ed-10962660a98d
Holgate, Stephen
2e7c17a9-6796-436e-8772-1fe6d2ac5edc
Wilson, Susan
21c6875d-6870-441b-ae7a-603562a646b8
Wallin, Annika, Sue-Chu, Malcolm, Bjermer, Leif, Ward, Jonathan, Sandström, Thomas, Lindberg, Anne, Lundbäck, Bo, Djukanovic, Ratka, Holgate, Stephen and Wilson, Susan
(2003)
Effect of inhaled fluticasone with and without salmeterol on airway inflammation in asthma.
Journal of Allergy and Clinical Immunology, 112 (1), .
(doi:10.1067/mai.2003.1518).
Abstract
Background: The clinical benefit of combining long-acting ?2-agonists with inhaled corticosteroids rather than doubling the dose of corticosteroid has been well-documented. However, there are concerns that this might result in a masking of underlying airway inflammation.
Objective: The aim of this study was to test the hypothesis that the addition of the long-acting ?2-agonist salmeterol (SALM) to a low dose of the inhaled corticosteroid fluticasone propionate (FP) has a steroid-sparing effect and does not result in a worsening of bronchial inflammation compared to doubling the dose of inhaled corticosteroid.
Methods: Fifty-six asthmatic subjects, previously not well-controlled on inhaled corticosteroids, were randomized to receive 3 months of treatment with inhaled FP 500 ?g twice a day (FP 1000) or FP 200 ?g twice a day plus SALM 50 ?g twice a day (FP 400 + SALM). Fluticasone propionate 200 ?g twice a day served as the control (FP400). Bronchial mucosal biopsy specimens, bronchial washings (BW), and bronchoalveolar lavage were obtained before and after treatment. The primary end points for the study were submucosal mast cell and eosinophil counts.
Results: There was a significant improvement in FEV1 in the FP400 + SALM group compared to both the FP400 and FP1000 groups. This was accompanied by a significant improvement in peak expiratory flow in the FP400 + SALM group in both the morning and evening compared to the FP1000 group. There were no significant between treatment differences in the change in the number of submucosal mast cells or eosinophils. However, in the FP400 + SALM group there was a significant decrease in submucosal mast cells after 12 weeks of treatment. The addition of SALM to FP was not associated with any increases in airway inflammation in the biopsy specimens, bronchoalveolar lavage, or bronchial washings.
Conclusion: These findings confirm that addition of SALM to FP has clinical benefits but does not mask or exacerbate airway inflammation and suggest that long-acting ?2-adrenoceptor agonists might influence mast cell numbers.
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Published date: July 2003
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Local EPrints ID: 27471
URI: http://eprints.soton.ac.uk/id/eprint/27471
ISSN: 0091-6749
PURE UUID: 6d4b8344-740d-4790-bf32-78cbb7628ce9
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Date deposited: 28 Apr 2006
Last modified: 16 Mar 2024 02:57
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Author:
Annika Wallin
Author:
Malcolm Sue-Chu
Author:
Leif Bjermer
Author:
Jonathan Ward
Author:
Thomas Sandström
Author:
Anne Lindberg
Author:
Bo Lundbäck
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