Comparison of anti-inflammatory and clinical effects of beclomethasone dipropionate and salmeterol in moderate asthma

Abstract

Inhaled corticosteroids and long-acting b 2 -agonists effectively control asthma symptoms and improve airway function. The effects of beclomethasone were compared with those of salmeterol on markers of eosinophilic inflammation in induced sputum in steroid-naïve asthmatic subjects with moderate asthma.Fifteen moderate asthmatics were treated with either beclomethasone dipropionate (500 mg b.i.d) or salmeterol (50 mg b.i.d) for 4 weeks, according to a randomised, double-blind, parallel-group study design. All patients underwent spirometry, methacholine test, sputum induction, and blood sampling before and after 2 and 4 weeks of treatment. They also recorded daily symptoms and peak expiratory flow (PEF).Sputum eosinophils, eosinophil cationic protein (ECP) and eosinophil protein X (EPX), and blood eosinophils, as well as the forced expiratory volume in one second (FEV1) and morning PEF, significantly improved after beclomethasone but not after salmeterol. PEF variability, the symptom score and rescue b 2 -agonist use significantly improved after both treatments, although the improvement in the symptom score tended to be greater after beclomethasone. After 2 and 4 weeks of beclomethasone treatment, both serum ECP and EPX decreased. With salmeterol, only serum EPX decreased, after 4 weeks. Bronchial hyperresponsiveness to methacholine did not change after either treatment.The authors conclude that beclomethasone, but not salmeterol, substantially improves airway inflammation in asthma. Beclomethasone also had an overall greater clinical effect, although the improvement in symptoms and peak expiratory flow variability was similar after both treatments. Eur Respir J 2002; 20: 66-72.

Transient sputum eosinophilia may occur over time in non‐eosinophilic asthma and this is not prevented by salmeterol

“…We decided to treat most patients with salmeterol, and not just with rescue salbutamol, in order to maintain a long‐lasting improvement in symptoms, without treating eosinophilic inflammation. The absence of a significant anti‐inflammatory effect of long‐acting beta2‐agonists is controversial; some investigators have observed minimal changes in airway inflammatory markers after salmeterol or formoterol treatment, 28,29 whereas other studies have shown no effect on sputum eosinophil numbers 7,30 . Therefore, in keeping with current guidelines, 1 we considered salmeterol to be devoid of significant anti‐inflammatory activity.…”

“…Therefore, in keeping with current guidelines, 1 we considered salmeterol to be devoid of significant anti‐inflammatory activity. We have previously demonstrated an acute effect of salmeterol on allergen‐induced eosinophilic inflammation; 31 however, this effect was lost after short‐term regular treatment with salmeterol alone 7,14 …”

“…Induced sputum analysis is more sensitive than blood analysis for detecting high eosinophil numbers 3,4 and may increase diagnostic accuracy, 5 predict loss of asthma control 5 and be helpful in the management of patients with severe asthma 6 . Inhaled corticosteroid (ICS) therapy reduces and often normalizes sputum eosinophil numbers, even after short periods of treatment 7 …”

Determinants of multidrug-resistant tuberculosis in patients who underwent first-line treatment in Addis Ababa: a case control study

“…When an individual who has no history of first-line TB treatment develops MDR-TB, it is termed primary. When insufficient treatment leads to selection of spontaneously resistant strains (i.e., drug resistance is acquired), the disease is termed secondary MDR-TB [2]. …”

Markers of airway inflammation in pulmonary diseases assessed by induced sputum

“…Eosinophil Cationic Protein (ECP) and Myeloperoxidase (MPO) are granulocyte proteins that are well correlated with eosinophil cell count [18] and decrease after anti-nflammatory treatment [19,20].…”