Bronchial reversibility with a short-acting β2-agonist predicts the FEV1 response to administration of a long-acting β2-agonist with inhaled corticosteroids in patients with bronchial asthma
- Authors:
- Akihiko Ohwada
- Kei Inami
- Emi Onuma
- Mariko Matsumoto‑Yamazaki
- Ryo Atsuta
- Kazuhisa Takahashi
View Affiliations
Affiliations: Ohwada Clinic, Ichikawa, Chiba 272-0023, Japan, Department of Respiratory Medicine, Juntendo University School of Medicine, Tokyo, Japan
- Published online on: May 12, 2011 https://doi.org/10.3892/etm.2011.268
-
Pages:
619-623
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Abstract
A long-acting β2-agonist (LABA) combined with an inhaled corticosteroid (ICS) is frequently prescribed as initial therapy in steroid-naïve asthma patients because of its effective control of symptoms and improvement of pulmonary function. However, it is unclear which patients will be responsive to LABAs and whether bronchial responsiveness to LABAs is similar to that to short-acting β2-agonists (SABAs) in a clinical setting. Therefore, the goal of the present study was to compare the changes in spirometric parameters after SABA (salbutamol) inhalation to those after 1-month LABA/ICS (salmeterol/fluticasone propionate) therapy. Spirometric changes were evaluated as absolute values, as the percentage of predicted normal values and as the percentage of baseline values after salbutamol inhalation or 1-month LABA/ICS therapy in 45 patients with asthma. Compared to SABA inhalation, LABA/ICS therapy produced significant improvements in forced expiratory volume in 1 sec (FEV1), peak expiratory flow (PEF), forced expiratory flow at 50% of vital capacity expired (FEF50%) from baseline (expressed as the percentage predicted) in all patients. FEV1 and the FEV1/forced vital capacity (FVC) ratio after SABA or LABA/ICS therapy were inversely related to the corresponding baseline values. Analysis of spirometric changes after SABA inhalation showed that FEV1 was the best among spirometric parameters, such as PEF, correlated with responsiveness to LABA/ICS therapy. Reversibility of FEV1 with SABA inhalation predicts the spirometric response to LABA/ICS as initial therapy in patients with bronchial asthma. LABA/ICS therapy had a greater effect on bronchial reversibility in asthmatic patients, compared to SABA inhalation. This suggested that evaluation of bronchial reversibility after LABA/ICS therapy would be superior to that after SABA inhalation.
View References
1.
|
Global Initiative for Asthma (GINA):
Global strategy for asthma management and prevention. NHLBI/WHO
Workshop Report. Bethesda: National Institutes of Health, National
Heart, Lung and Blood Institute, Upgrade; 2009
|
2.
|
Ni Chroinin M, Greenstone I, Lasserson TJ
and Ducharme FM: Addition of inhaled long-acting beta2-agonists to
inhaled steroids as first line therapy for persistent asthma in
steroid-naive adults and children. Cochrane Database Syst Rev.
7:CD0053072009.
|
3.
|
Pellegrino R, Viegi G, Brusasco V, et al:
Interpretative strategies for lung function tests. Eur Respir J.
26:948–968. 2005. View Article : Google Scholar : PubMed/NCBI
|
4.
|
Miller MR, Hankinson J, Brusasco V, et al:
Standardisation of spirometry. Eur Respir J. 26:319–338. 2005.
View Article : Google Scholar : PubMed/NCBI
|
5.
|
American Thoracic Society: Lung function
testing: selection of reference values and interpretative
strategies. Am Rev Respir Dis. 144:1202–1218. 1991. View Article : Google Scholar : PubMed/NCBI
|
6.
|
Lehtimäki L, Kankaanranta H, Saarelainen
S, Turjanmaa V and Moilanen E: Peripheral inflammation in patients
with asthmatic symptoms but normal lung function. J Asthma.
42:605–609. 2005.PubMed/NCBI
|
7.
|
Nelson HS, Weiss ST, Bleecker ER, Yancey
SW and Dorinsky PM; SMART Study Group: The Salmeterol Multicenter
Asthma Research Trial: a comparison of usual pharmacotherapy for
asthma or usual pharmacotherapy plus salmeterol. Chest. 129:15–26.
2006. View Article : Google Scholar
|
8.
|
Chowdhury BA and Pan GD: The FDA and safe
use of long-acting beta-agonists in the treatment of asthma. N Engl
J Med. 362:1169–1171. 2010. View Article : Google Scholar : PubMed/NCBI
|
9.
|
Dobashi K: Epidemiology of asthma.
Igaku-No-Ayumi. 233:5–12. 2010.(In Japanese).
|
10.
|
Chatenoud L, Malvezzi M, Pitrelli A, La
Vecchia C and Bamfi F: Asthma mortality and long-acting
beta2-agonists in five major European countries, 1994–2004. J
Asthma. 46:546–551. 2009.PubMed/NCBI
|
11.
|
Brand PL, Quanjer PH, Postma DS, et al:
Interpretation of bronchodilator response in patients with
obstructive airways disease. The Dutch Chronic Non-Specific Lung
Disease (CNSLD) Study Group. Thorax. 47:429–436. 1992. View Article : Google Scholar : PubMed/NCBI
|
12.
|
Beach JR, Young CL, Stenton SC, Avery AJ,
Walters EH and Hendrick DJ: A comparison of the speeds of action of
salmeterol and salbutamol in reversing methacholine-induced
bronchoconstriction. Pulm Pharmacol. 5:133–135. 1992. View Article : Google Scholar : PubMed/NCBI
|
13.
|
Yancey SW and Ortega HG: Retrospective
characterization of airway reversibility in patients with asthma
responsive to bronchodilators. Curr Med Res Opin. 23:3205–3207.
2007. View Article : Google Scholar : PubMed/NCBI
|