A 4-WEEK COMPARISON OF SALMETEROL AND TERBUTALINE IN ADULT ASTHMA

This was a 4-week, open-label, parallel-group study designed to compar e the efficacy and safety of the long-acting inhaled bronchodilator, s almeterol, with the established inhaled bronchodilator, terbutaline, i n the treatment of patients with mild to moderate asthma. A total of 2 43 adult patients was randomized to receive treatment with either salm eterol 50 mu g bd via a Diskhaler(TM) (Glare) inhaler (n = 121)or terb utaline 500 mu g qds via a reservoir powder inhaler device (n = 122). Apart from all bronchodilator treatment which was withdrawn at the sta rt of the run-in period and replaced by inhaled salbutamol to be used as required for symptom relief, all concurrent medications were kept c onstant throughout the study. Salmeterol produced a significantly grea ter increase in mean morning peak expiratory how (PEF) than terbutalin e (difference in adjusted means after treatment = 28 l/min; 95% CI = 1 9-37 l/min; P<0.001). Likewise, the increase in mean evening PEF was s ignificantly greater following treatment with salmeterol than with ter butaline (difference in adjusted means = 9 l/min; 95% CI = 0-17 l/min; P = 0.045). Salmeterol was associated with a significant reduction in diurnal variation in PEF by comparison with terbutaline (difference i n adjusted means = -18 l/min; 95% CI = -24, -12 l/min; P<0.001), Signi ficant improvements with salmeterol by comparison with terbutaline wer e also observed in daytime and night-time asthma scores, percentage of symptom-free days and nights, use of additional inhaled bronchodilato r, and percentage of days and nights when no additional inhaled bronch odilator was needed. The greater overall improvement in the control of asthma and its symptoms after treatment with salmeterol was further e vident from the lower incidence of asthma-related adverse events in pa tients taking salmeterol compared with those taking terbutaline (2% an d 15%, respectively). While both treatments were well tolerated, more patients withdrew from the terbutaline group than from the salmeterol group (12 and 3 patients, respectively) and terbutaline was associated with a higher incidence of drug-related adverse events (26% and 9% in the terbutaline- and salmeterol-treated groups, respectively). This s tudy demonstrated that salmeterol 50 mu g bd via a Diskhaler was signi ficantly more effective and associated with fewer adverse events than terbutaline 500 mu g qds via a reservoir powder inhaler device.