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Clinical Trial
, 339 (3), 141-6

Effect of Long-Term Salmeterol Treatment on Exercise-Induced Asthma

Affiliations
Clinical Trial

Effect of Long-Term Salmeterol Treatment on Exercise-Induced Asthma

J A Nelson et al. N Engl J Med.

Abstract

Background: With long-term administration of salmeterol, the extent of protection afforded by the drug against experimental precipitants of asthma such as methacholine and adenosine may decrease. Whether this effect extends to a clinically relevant stimulus such as exercise is unknown.

Methods: We performed a random-order, double-blind, crossover trial in 20 patients with exercise-induced asthma. Each patient received inhaled salmeterol or placebo twice daily for a month, with a one-week washout period between treatments. The patients performed cycle ergometry while breathing frigid air 30 minutes after the morning dose and 9 hours later on the 1st, 14th, and 29th study days. The primary end point was the extent of the decrease in forced expiratory volume in 1 second (FEV1) 10 minutes after exertion.

Results: With placebo, significant airway narrowing developed at all times (mean [+/-SE] decrease from base line in FEV1, 19+/-2 percent in the morning and 18+/-2 percent in the evening). The morning dose of salmeterol attenuated the degree of bronchoconstriction at all times (decrease in FEV1 on day 1, 5+/-2 percent; on day 14, 10+/-3 percent; and on day 29, 9+/-3 percent; P=0.10). Its ability to act throughout the day, however, decreased with long-term administration (decrease in FEV1 from morning to evening on day 1, 6+/-2 percent; on day 14, 15+/-3 percent; and on day 29, 14+/-3 percent; P=0.003).

Conclusions: Protection against exercise-induced asthma is maintained with long-term administration of salmeterol, but the length of time that the drug remains active after a single dose decreases.

Comment in

  • New treatments for exercise-induced asthma.
    Hansen-Flaschen J, Schotland H. Hansen-Flaschen J, et al. N Engl J Med. 1998 Jul 16;339(3):192-3. doi: 10.1056/NEJM199807163390309. N Engl J Med. 1998. PMID: 9664097 No abstract available.
  • Exercise-induced asthma.
    Aziz I, Lipworth BJ. Aziz I, et al. N Engl J Med. 1998 Dec 10;339(24):1783; author reply 1785. doi: 10.1056/NEJM199812103392412. N Engl J Med. 1998. PMID: 9867553 No abstract available.
  • Exercise-induced asthma.
    Dickey BF, Adachi R. Dickey BF, et al. N Engl J Med. 1998 Dec 10;339(24):1783-4; author reply 1785. N Engl J Med. 1998. PMID: 9867554 No abstract available.
  • Exercise-induced asthma.
    Honig PK, Jenkins JK. Honig PK, et al. N Engl J Med. 1998 Dec 10;339(24):1784; author reply 1785-6. N Engl J Med. 1998. PMID: 9867555 No abstract available.
  • Exercise-induced asthma.
    Stempel DA. Stempel DA. N Engl J Med. 1998 Dec 10;339(24):1784; author reply 1785. N Engl J Med. 1998. PMID: 9867556 No abstract available.

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