N. Crimi et al., EFFECT OF ORAL TERFENADINE ON BRONCHOCONSTRICTOR RESPONSE TO INHALED NEUROKININ-A AND HISTAMINE IN ASTHMATIC SUBJECTS, The European respiratory journal, 6(10), 1993, pp. 1462-1467
Neurokinin A (NKA) elicits a potent contractile effect in asthmatic ai
rways. Its mechanism of action in bronchial asthma is still unknown. R
ecent work supports the view that NKA may stimulate mediator release f
rom mast cells. To investigate the relative contribution of mast cell
degranulation to the action of NKA, a randomized, double-blind study h
as been undertaken, to evaluate the effect of a potent and selective h
istamine H-1-receptor antagonist, terfenadine (180 mg q.d., for three
days), on bronchoconstriction provoked by inhaled NKA in six asthmatic
subjects. Bronchial provocation tests with histamine were included in
this study as control challenge. In the subjects studied, oral terfen
adine, when compared to placebo, significantly increased the geometric
mean (range) provocation dose of inhaled histamine required to reduce
forced expiratory volume in one second (FEV1) by 20% of baseline (PD2
0) from 0.05 (0.03-0.08) mg (0.16 (0.10-0.26) mumol) to 1.19 (0.63-2.0
4) mg (3.88 (2.05-6.64) mumol). However, terfenadine failed to increas
e the airway responsiveness to NKA in all of the subjects studied, the
geometric mean (range) PD15 NKA value being 0.94 (0.47-2.49) mug (8.3
6 (4.14-21.9 nmol) and 0.75 (0.48-1.59) mug (6.62 (4.23-14.0) nmol) af
ter placebo and terfenadine, respectively. We conclude that NKA is a p
otent bronchoconstrictor agonist in asthma, being approximately 19 tim
es more potent than histamine in molar terms. In this study on a small
number of subjects, pharmacological intervention with oral terfenadin
e failed to achieve significant protection of the airways against the
constrictor effect of NKA. Thus, it is unlikely that the bronchoconstr
iction provoked by inhaled NKA in asthma is mediated through histamine
release from airway mast cells.