D. Giannini et al., Inhaled beclomethasone dipropionate reverts tolerance to the protective effect of salmeterol on allergen challenge, CHEST, 115(3), 1999, pp. 629-634
Citations number
26
Categorie Soggetti
Cardiovascular & Respiratory Systems","Cardiovascular & Hematology Research
Study objective: One week of regular treatment with salmeterol can induce t
olerance to the protective effect of a beta(2)-agonist on early airway resp
onse to allergen (EAR). The objective was to assess whether inhaled cortico
steroids revert tolerance to salmeterol. Study design: The study had a rand
omized, double-blind, placebo-controlled design.
Patients and methods: Twelve subjects with mild allergic asthma and positiv
e result of specific bronchial provocation test (sBPT) to allergen underwen
t three sBPTs, separated by 1 week. sBPT was done in all subjects after a s
ingle dose (T-1) and after 1 week of regular treatment with inhaled salmete
rol (50 mu g bid) (T-2) in order to induce tolerance. Subjects were then ra
ndomized to receive either the same dose of salmeterol + beclomethasone dip
ropionate (BDP, 500 mu g bid) (group 1, n = 6) or placebo + BDP (group 2, n
= 6) for 1 week before sBPT (T-3).
Results: After a single dose of salmeterol (T-1), all subjects were protect
ed against EAR, whereas after 1 week of regular treatment, the protective e
ffect of salmeterol was totally or partially lost (T-2). Maximum FEV1 perce
nt fall (Max Delta FEV1%) after allergen inhalation was significantly highe
r at T-2 than at T-1. All subjects except one of group 1 were protected aga
inst EAR after salmeterol + BDP (T-3), and Max Delta FEV1% at T-3 (median,
12%; range, 4 to 6%) was significantly lower than T-2 (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 (T-3) Max
Delta FEV1% at T-2 (median, 31%; range, 9 to 40%) and T-3 (median, 31%; ra
nge, 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 l
ost after 1 week of regular treatment with salmeterol alone. This ability o
f BDP in reverting tolerance cannot be ascribed to a direct effect of corti
costeroids per se on allergen challenge in this group of asthmatics.