Influence of beclomethasone and salmeterol on the perception of methacholine-induced bronchoconstriction

Chest. 1998 Aug;114(2):373-9. doi: 10.1378/chest.114.2.373.


Background: Patient evaluation of asthma severity and medication needs is mostly based on respiratory symptoms and may be influenced by changes in perception of bronchoconstriction-induced sensations. However, the influence of asthma medication on the ability to perceive symptoms is still to be documented. This study evaluated the effects of short-term and regular use of salmeterol on the perception of methacholine-induced bronchoconstriction (MIB) in subjects with mild asthma, using inhaled salbutamol on an "as required" basis (n=15), and in subjects with moderate asthma, using daily inhaled beclomethasone (mean daily dose, 640 microg; n=15) in addition to salbutamol to control their asthma.

Methods: Methacholine challenges (MC) were performed at entry into the study, and then before, 1, and 12 h following inhalation of 50 microg of salmeterol or a placebo, after a 15-day baseline period; and after 4 weeks of twice daily use of those treatments. The measurements were then repeated with the alternate treatment after a 15-day washout period. Finally, a last MC was performed after another 15-day washout period. For each MC, the perception score of bronchoconstriction-associated breathlessness at 20% fall in FEV1 (PS20) was evaluated on a modified Borg scale from 0 to 10.

Results: Subjects using regular beclomethasone had a higher baseline PS20 than those using only salbutamol (means: 3.06 0.06 and 2.01+/-0.07, p=0.0001). Short- and long-term use of salmeterol did not change significantly the PS20 compared with placebo (p>0.05) in either group (with or without corticosteroid). Although there were some intraindividual variations, mean PS20 did not vary significantly throughout the study.

Conclusion: These observations show that the perception of bronchoconstriction-associated breathlessness is not influenced by regular use of salmeterol. Patients using inhaled corticosteroids show a greater perception of MIB.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Administration, Inhalation
  • Adolescent
  • Adult
  • Albuterol / administration & dosage
  • Albuterol / analogs & derivatives*
  • Albuterol / therapeutic use
  • Asthma / diagnosis
  • Asthma / drug therapy
  • Asthma / physiopathology
  • Beclomethasone / administration & dosage
  • Beclomethasone / therapeutic use*
  • Bronchoconstriction / drug effects*
  • Bronchoconstrictor Agents*
  • Bronchodilator Agents / administration & dosage
  • Bronchodilator Agents / therapeutic use*
  • Cross-Over Studies
  • Double-Blind Method
  • Female
  • Follow-Up Studies
  • Forced Expiratory Volume / drug effects
  • Glucocorticoids / administration & dosage
  • Glucocorticoids / therapeutic use*
  • Humans
  • Male
  • Methacholine Chloride*
  • Middle Aged
  • Perception
  • Salmeterol Xinafoate
  • Severity of Illness Index
  • Treatment Outcome


  • Bronchoconstrictor Agents
  • Bronchodilator Agents
  • Glucocorticoids
  • Methacholine Chloride
  • Salmeterol Xinafoate
  • Beclomethasone
  • Albuterol