HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:
Guest Access | Sign In via User Name/Password

This Article Full Text Free Full Text (PDF) Free Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to My Personal Article Archive Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (27) Citing Articles via Google Scholar Google Scholar Articles by Giannini, D. Articles by Paggiaro, P. Search for Related Content PubMed PubMed Citation Articles by Giannini, D. Articles by Paggiaro, P.

Inhaled Beclomethasone Dipropionate Reverts Tolerance to the Protective Effect of Salmeterol on Allergen Challenge^*

^* From the Cardiothoracic Department (Drs. Giannini, Bacci, Dente, Di Franco, Vagaggini, and Paggiaro), University of Pisa, Pisa, Italy, and Glaxo Wellcome (Dr. Testi), Verona, Italy.

Study objective: One week of regular treatment with salmeterol can induce tolerance to the protective effect of a ß₂-agonist on early airway response to allergen (EAR). The objective was to assess whether inhaled corticosteroids revert tolerance to salmeterol.

Study design: The study had a randomized, double-blind, placebo-controlled design.

Patients and methods: Twelve subjects with mild allergic asthma and positive result of specific bronchial provocation test (sBPT) to allergen underwent three sBPTs, separated by 1 week. sBPT was done in all subjects after a single dose (T₁) and after 1 week of regular treatment with inhaled salmeterol (50 µg bid) (T₂) in order to induce tolerance. Subjects were then randomized to receive either the same dose of salmeterol + beclomethasone dipropionate (BDP, 500 µg bid) (group 1, n = 6) or placebo + BDP (group 2, n = 6) for 1 week before sBPT (T₃).

Results: After a single dose of salmeterol (T₁), all subjects were protected against EAR, whereas after 1 week of regular treatment, the protective effect of salmeterol was totally or partially lost (T₂). Maximum FEV₁ percent fall (MaxFEV₁%) after allergen inhalation was significantly higher at T₂ than at T₁. All subjects except one of group 1 were protected against EAR after salmeterol + BDP (T₃), and MaxFEV₁% at T₃ (median, 12%; range, 4 to 6%) was significantly lower than T₂ (median, 22%; range, 12 to 43%; p < 0.05 by Wilcoxon test). Subjects of group 2 did not show any significant protection against EAR after placebo + BDP treatment (T₃) MaxFEV₁% at T₂ (median, 31%; range, 9 to 40%) and T₃ (median, 31%; range, 3 to 42%; not significant).

Conclusions: In conclusion, the addition of inhaled BDP partially restored the bronchoprotective effect of salmeterol on allergen challenge that was lost after 1 week of regular treatment with salmeterol alone. This ability of BDP in reverting tolerance cannot be ascribed to a direct effect of corticosteroids per se on allergen challenge in this group of asthmatics.

Key Words: allergen challenge • asthma • ß₂-agonist • inhaled corticosteroids • salmeterol • tolerance

This article has been cited by other articles:

				E. Bateman, H. Nelson, J. Bousquet, K. Kral, L. Sutton, H. Ortega, and S. Yancey Meta-analysis: Effects of Adding Salmeterol to Inhaled Corticosteroids on Serious Asthma-Related Events Ann Intern Med, June 3, 2008; (2008) 0000605-200807010-00229. [Abstract] [Full Text]

				G.P. Currie, C.M. Jackson, S.A. Ogston, and B.J. Lipworth Airway-stabilizing effect of long-acting {beta}2-agonists as add-on therapy to inhaled corticosteroids QJM, June 1, 2003; 96(6): 435 - 440. [Abstract] [Full Text] [PDF]

				N. J. Vanacker, E. Palmans, R. A. Pauwels, and J. C. Kips Effect of Combining Salmeterol and Fluticasone on the Progression of Airway Remodeling Am. J. Respir. Crit. Care Med., October 15, 2002; 166(8): 1128 - 1134. [Abstract] [Full Text] [PDF]

				D. Giannini, A. Di Franco, E. Bacci, F. L. Dente, M. L. Bartoli, B. Vagaggini, and P. Paggiaro Tolerance to the Protective Effect of Salmeterol on Allergen Challenge Can Be Partially Restored by the Withdrawal of Salmeterol Regular Treatment Chest, June 1, 2001; 119(6): 1671 - 1675. [Abstract] [Full Text] [PDF]

				D R Taylor and R J Hancox Interactions between corticosteroids and beta agonists Thorax, July 1, 2000; 55(7): 595 - 602. [Full Text]

				G. P. ANDERSON Interactions between Corticosteroids and beta -Adrenergic Agonists in Asthma Disease Induction, Progression, and Exacerbation Am. J. Respir. Crit. Care Med., March 1, 2000; 161(3): S188 - 196. [Full Text] [PDF]

				D. W. Cockcroft, B. E. Davis, V. A. Swystun, D. Giannini, and P. Paggiaro Salmeterol, Inhaled Corticosteroids, and Tolerance to Allergen Bronchoprotection Chest, November 1, 1999; 116(5): 1497 - 1498. [Full Text] [PDF]