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Bronchodilator Effect of Infused B-Type Natriuretic Peptide in Asthma^*

Michael J. Akerman, MD; Makito Yaegashi, MD^,; Zothanmawii Khiangte, MD; Anandhi T. Murugan, MD; Olumayowa Abe, MD and Jonathan D. Marmur, MD

^* From the Divisions of Pulmonary and Critical Care Medicine (Drs. Akerman, Yaegashi, and Khiangte) and Cardiology (Dr. Marmur), and the Department of Medicine (Drs. Murugan and Abe), State University of New York, Health Science Center at Brooklyn, Brooklyn, NY. Dr. Akerman and Dr. Yaegashi contributed equally to this work. Dr. Yaegashi is currently located at the Department of Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA.

Correspondence to: Michael J. Akerman, MD, Division of Pulmonary and Critical Care Medicine, State University of New York, Health Science Center at Brooklyn, 450 Clarkson Ave, Box 19, Brooklyn, NY 11203; e-mail: Michael.akerman{at}downstate.edu

Abstract

Study objective: To determine the bronchodilator effect of recombinant human B-type natriuretic peptide (BNP; nesiritide) on patients with asthma.

Design: A prospective, open-label study.

Setting: Outpatient setting.

Patients: Eight adult patients with asthma confirmed by > 12% and > 200 mL increase in FEV₁ after bronchodilator inhalation.

Interventions: An IV nesiritide bolus, 2 µg/kg, followed by continuous infusion for a total of 3 h at escalating doses of 0.01, 0.02, and 0.03 µg/kg/min for 1 h each as tolerated.

Measurements: Spirometry and forced oscillation technique (FOT) measurements were both obtained at baseline and every 30 min during the infusion. Two doses of albuterol, 90 µg, inhalation via metered-dose inhaler were then administered at the end of nesiritide infusion, followed by repeat spirometry and FOT measurements after 30 min. Primary end points were FEV₁ and FVC changes after the nesiritide infusion for 3 h. Wilcoxon signed-ranks tests were used to compare the effects of nesiritide and albuterol.

Results: Baseline measurements (mean ± SD) were as follows: FEV₁, 1.89 ± 0.87 L; FVC, 3.02 ± 0.99 L; respiratory resistance at 5 Hz (Rrs5), 10.3 ± 3.85 cm H₂O · s/L; and mean respiratory resistance at 5 to 20 Hz, 7.56 ± 1.92 cm H₂O/L/s. Mean baseline serum BNP level was 27 ± 27 pg/mL. After 180 min of nesiritide infusion, the following measurements showed significant changes: FEV₁ increased to 2.41 ± 0.78 L (mean increase, 520 mL), p = 0.012; FVC increased to 3.65 ± 1.05 L (mean increase, 630 mL), p = 0.017; and Rrs5 decreased to 8.24 ± 4.02 cm H₂O/L/s, p = 0.017. After albuterol, there were no further significant changes in these measurements.

Conclusion: IV nesiritide is an effective bronchodilator in patients with asthma.

Key Words: asthma • atrial natriuretic factor • bronchodilators • B-type natriuretic peptide • nesiritide