Effect of inhaled indomethacin in asthmatic patients taking high doses of inhaled corticosteroids

Background: Cyclooxygenase products of arachidonic acid may play a part in bronchoconstriction and airway inflammation in asthma. Objective: We sought to determine the effect of inhaled indomethacin on ast hma control and asthma exacerbations during reduction of inhaled corticoste roids in patients with moderate-to-severe steroid-dependent asthma. Methods: We conducted a double-blind, randomized, parallel-group, multicent er study in 38 patients with asthma taking high doses (greater than or equa l to 1500 mu g/d) of beclomethasone dipropionate (BDP). After a run- in per iod, patients were assigned inhaled indomethacin (50 mg/d) or placebo for 6 weeks, during which the daily doses of BDP were reduced to half at week 2 and then to one third of the baseline dose at week 4. Results: Data were available from 34 patients. After the reduction of BDP d oses, FEV1, peak expiratory flow, asthma symptoms, and exhaled nitric oxide concentrations deteriorated in both treatment groups, but these effects we re less pronounced in the indomethacin group compared with the placebo grou p. During the 6-week treatment period, 89% of the patients receiving placeb o had relapse of asthma, whereas only 38% of those receiving inhaled indome thacin did so (P = .003). Conclusion: Inhalation of indomethacin can reduce asthma exacerbations indu ced by reduction of high-dose inhaled corticosteroid in steroid-dependent a sthma.