Guideline topic: Pharmacological management of asthma
Evidence table 4.3e: Anti-histamines for exercise-induced asthma

Author

Year

Study type

Quality rating

Population

Outomes measured

Effect size

Confidence intervals / p values

Comments

Finnerty¹

1990

Randomised, double-blind, placebo-controlled, cross-over.
Single-dosing with terfenadine 180mg, flurbiprofen 150mg and both.

++

8 adults with asthma.

Not on regular treatment.

Exercise-induced bronchoconstriction

% fall in FEV1:

Placebo: 39%

Terfenadine: 25%

Flurbiprofen: 27%

Combination: 30%

p< 0.05

p< 0.05

NS

Both terfenadine and flurbiprofen provided some attenuation of EIA compared to placebo. Interestingly, the combination did not.

Gong²

1990

Randomised, double-blind, placebo-controlled, cross-over.
Single dosing with cetrizine 5mg, 10mg, 20mg, salbutomol 4mg.

++

10 adults with asthma

Exercise-induced bronchoconstriction

% fall in FEV1:

Placebo: 37%

Cetirizine 5mg: 42%

Cetrizine 10mg: 44%

Cetrizine 20mg: 43%

Salbutamol 4mg: 32%

NS

NS

NS

NS

Both oral cetirizine and salbutamol had no effect on EIA.

Magnussen³

1988

Randomisec, double-blind, placebo-controlled, cross-over.
Single-dosing with azelastine 4.4mg.

++

10 adults with asthma.

Not on regular treatment.

Exercise-induced bronchoconstriction

D FEV1 %:

D Raw %:

D Sraw%:

Pre vs Post-exercise with azelastine:

27% vs 15%

170% vs 98%

229% vs 138%

p< 0.01

p< 0.01

p< 0.01

Azelastine provided partial protection against EIA.

Patel⁴

1984

Randomised, double-blind, placebo-controlled, cross-over.
Single-dosing with terfenadine 60mg, 120mg and 180 mg.

++

10 adults with asthma.

Not on oral or inhaled steroids.

Exercise-induced bronchoconstriction

% fall in FEV1

Placebo: 33%

Terfenadine 60mg: 28%

Terfenadine 120mg: 23%

Terfenadine 180mg: 21%

NS

p< 0.02

p< 0.01

Small number of subjects.

Although there was a statistical difference detected, there was only a minor attenuation of EIA.