SELECTED ARTICLES FROM THE RECENT LITERATURE 2005

10/12/05

Does inhaled formoterol have anti-inflammatory activity?

Summary
Background - Addition of an inhaled long acting beta agonist (LABA) such as formoterol (Form) to a low dose of inhaled corticosteroids (ICS) frequently provides better asthma control than doubling the ICS dose. The mechanism underlying this beneficial effect of Form is not clearly defined, with the possibility that Form may have anti-inflammatory effects of its own on the lower airways.

Findings - Overbeek et al of the Erasmus Medical Center, Rotterdam, Netherlands carried out a double blind, parallel group comparison of budesonide (BUD), an ICS, 100 mcg b.i.d. plus placebo vs BUD 100 mcg b.i.d. plus Form 12 mcg b.i.d.. This was carried out for 8 weeks in 40 adults with persistent asthma. Then the dose of BUD was increased to 400 mcg b.i.d. in all subjects. Bronchial biopsies were obtained at baseline and after 8 and 16 weeks of treatment.

There was a marked decreased in bronchial eosinophil frequency and moderate decrease in bronchial mast cell frequency after 8 weeks of either BUD plus placebo or BUD plus Form with no significant difference between the 2 treatment regimens. Further treatment with an increased dose of BUD (400 mcg b.i.d.) during the second 8 weeks led to no additional reduction of bronchial eosinophils or mast cells.

Reference
Chest 2005;128:121-7

Editor's Comments
These findings indicate that even a relatively low dose of BUD (200 mcg/day) exerted significant anti-inflammatory effects in the asthmatic airways without additional anti-inflammatory effects when Form treatment was added to BUD or when the BUD dose was increased to 800 mcg/day for 8 weeks. The authors described their study group as having mild asthma (although the FEV-1 of this group ranged from 50%-90% of predicted). Therefore, it would be of interest to see whether a similar pattern of findings would be seen in those with severe asthma. One would also want to know whether clinical symptoms and/or spirometric findings in these subjects were benefited more by the BUD plus Form treatment than by BUD treatment alone.

 

<-- BACK