SELECTED ARTICLES FROM THE RECENT LITERATURE 2006

11/28/06

Effects of formoterol inhalation on exercise induced bronchoconstriction

Summary
Background - Exercise induced bronchoconstriction (EIB) is very common in children. In clinical practice, children with EIB are usually pre-treated with inhaled beta agonists (IBA) such as albuterol (Alb) before significant exercise. Formoterol (Form) is a unique IBA with onset of bronchodilating effect as rapid as Alb but with a much longer duration of effect (as long as 12 hours in some individuals).

Findings - Pearlman et al of the Colorado Allergy and Asthma Centers in Denver, CO carried out a randomized, double blind crossover comparison of Form 12 or 24 mcg vs Alb 180 mcg vs placebo inhaled by 23 children (ages 4-11 years) with previously documented EIB. Treadmill exercise challenges were then carried out at various times after the pre-treatment.

They found that both doses of Form, inhaled 4 hours before exercise, were more effective in reducing the exercise induced decrease in the FEV-1 than was inhaled Alb (p=0.01) or placebo (p<0.001) pre-treatment. A similar pattern of events was seen following exercise 8 hours after the pre-treatment (on a separate day).

Overall, pre-treatment was completely protective: 1) about 75% of the time after Form pre-treatment; 2) 35% of the time after Alb pre-treatment and 3) 27% of the time after placebo pre-treatment.

Reference
Ann Allergy Asthma Immunol 2006;97:382-8

Editor's Comments
These findings are of interest on several accounts. Pre-treatment with inhaled Alb (the customary approach) is really not that effective in reducing EIB when exercise is carried out at least 4 hours later. Since children are often involved in running sports and exercise lasting several hours, pre-treatment with a longer-acting agent such as inhaled Form may be needed.

 

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