INHALED SALMETEROL AND ALBUTEROL IN ASTHMATIC-PATIENTS RECEIVING HIGH-DOSE INHALED CORTICOSTEROIDS

Salmeterol may be useful in the treatment of asthmatic patients requiring high-dose inhaled steroids, and there have been debates about its anti-inflammatory action. We have compared the efficacy and effects on serum inflammatory markers, including soluble interleukin 2R (sIL-2R), eosinophil cationic protein (ECP), and tryptase of salmeterol and albuterol in 20 patients with moderate to severe asthma who were all receiving high-dose inhaled corticosteroids and inhaled beta(2)-agonist on demand. After a e-week run-in period, they received, in a randomized, crossover, double-blind and placebo-controlled manner, either salmeterol, 50 mu g twice a day, or albuterol 400 mu g, four times a day, from a powder inhaler during two 2-week treatment periods, separated by a 2-week washout. Compared with albuterol, salmeterol treatment was associated with better morning and mean peak expiratory flow (p=0.013 and 0.016, respectively), less daytime and nocturnal symptoms (p=0.008 and 0.01, respectively), reduced requirement of rescue albuterol (p=0.04), and better efficacy rating by patients (p=0.04). However, serum concentration of sIL-2R was significantly higher during regular albuterol treatment (p=0.014) but no differences were seen in the concentrations of ECP and tryptase between the two treatment periods. We conclude that inhaled salmeterol, 50 mu g twice daily, confers a better control of asthma than albuterol, 400 mu g four times daily, in patients with moderate to severe disease, and the latter treatment may be associated with increased T-lymphocyte activation.