Guideline topic: Pharmacological management of asthma
Evidence table 4.3a: Long acting B2 agonists in exercise induced asthma

Author

Adults

Nelson JA, Strauss L, Skowronski M et al¹

1998

A single random-order double bloind cross-over controlled trial
One week wash-out period between cross-over periods

++

20 patients (29± 9 yr) with exercise- induced asthma. 29 day study. Attending Case Western Reserve University School of Medicine.
Inhaled salmeterol 42 mcg twice daily vs. placebo for one month.

FEV,: morning; post-exercise & evening; 9 hr later (pre the evening dose)

Placebp: FEV, decrease morning 19% (SE 2%), evening 18% (SE 2%)

Salmeterol:
Morning FEV, decrease

Day1: 6% (SE 2%)
Day 14: 15 (SE 3%)
Day 29: 14 (SE 3%)
Morning to evening FEV, decrease

Day 1: 6% (SE 2%)

Day 14: 15 (SE 3%)

Day 29: 14 (SE 3%)

P=< 0.001

P = 0.1

P = 0.003

P = 0.02 c.f. day 14

P = 0.29 c.f. placabo

Shows that the prolonged (+ 9 hr)

Protection from exercise-induced symptoms, by salmeterol, reduces after 14 days to less than clinically significant levels.

Sample size small.

Partly supported by a grant from the manufacturers of salmeterol.

Sichletidis I, Daskalopoulou E, Kyriazis G, et al²

1993

A single randomised, double blind cross-over controlled trial

+

12 patienrs (20-44 yr) with mild, stable extrinsic asthma, exercise-induced with no late phase reaction.

Attending George Papanicolaou General Hospital, Thessaloniki

Inhaled salbutamol 200mcg, inhaled salmeterol 50mcg, single dosing

% bronchospasm after exercise test

(PEFR before-PEFR afterx100)/PEFR before exercise

1hr post-admin

4hr post admin

12hr post admin

% bronchodilation after exercise test

1hr post-admin

Serum histamine
1hr post admin
Before exercise

After exercise

6hr post admin

Before exercise

After exercise

12hr post admin

Before exercise

After exercise

PgD3 & LKTC4 levels

Salbutamol 4.4+/-3.6%
Salmeterol 3.3+/-4.4%
Placebo 28.6+/-3.8%


Salbutamol 20+/-12.8%
Salmeterol 10.8+/-9%

Salbutamol 27.3+/-10.5%
Salmeterol 10.9+/-9%







Salbutamol 16+/-2%
Salmeterol 14+/-6%
Placebo 1+/-3%



Salbutamol 2.71+/-1.41
Salmeterol 3.54+/-1.89

Salbutamol 4.04+/1.51-Salmeterol 5.43+/-2.83

Salbutamol 4.75+/-2.73

Salmeterol 3.07+/-1.1

Salbutamol 13.82+/-10.79

Salmeterol 3.56+/-2

Salbutamol 9.97+/-5.81

Salmeterol 6.13+/-2.9

Salbutamol 26.4+/-12.66

Salmeterol 14.58+/-10.83

Difference
P<0.001

Difference
P<0.01

NS

P<0.01

NS

P<0.01

P<0.05

P<0.05

Small sample size. Confirms that salbutamols duration of action is < 6 hours and salmeterol > 12 hours in the prevention of exercise induced asthma.