Comparison of inhaled salmeterol and individually dose-titrated slow-release theophylline in patients with reversible airway obstruction. European Study Group

Abstract

The median percentage of nights with no asthma symptoms rose from 14% in both groups at baseline to 71% with salmeterol and to 46% with theophylline (p=0.044). There was also a significant increase for salmeterol in the median percentage of nights with no rescue salbutamol use (from 36 to 86%) compared with theophylline (from 71 to 78%; p=0.002). The mean morning PEF increased from 337 L·min -1 in the salmeterol group and 332 L·min -1 in the theophylline group to 372 and 357 L·min -1 , respectively. No significant difference between the two treatments was observed for PEF, symptoms or additional salbutamol medication during the day. The incidence of gastrointestinal symptoms (gastric irritation, nausea and vomiting) was greater among patients receiving theophylline (11%) than with salmeterol (3%).These findings suggest that inhaled salmeterol is more effective in relieving symptoms of asthma, and better tolerated than theophylline in patients with moderateto-severe asthma. Eur Respir J., 1996Respir J., , 9, 1689Respir J., -1695 The clinical efficacy of salmeterol, the first of a new class of long-acting β 2 -agonists, has been demonstrated in comparison with other short-acting β 2 -agonists, such as salbutamol and terbutaline [1,2]. As oral theophylline is an asthma drug widely used in many countries, especially in Europe, this study was planned to compare the effects of salmeterol with oral slow-release theophylline. The new slow-release preparations of oral theophylline allow quite stable levels of serum theophylline concentration with one or two daily administrations, and they are commonly accepted for treatment of chronic reversible airway obstruction [3]. In this respect, the comparison between oral slow-release theophylline and salmeterol, both drugs with a long-lasting (up to 12 h) bronchodilation achieved by twice daily administration, seems of particular interest for long-term treatment of reversible airway obstruction. In a previous study, the effect of salmeterol was compared with theophylline over 2 weeks in a double-blind, cross-over study [4], showing that salmeterol produced a better effect on asthma symptoms and peak expiratory flow (PEF) values than theophylline in subjects with moderate asthma. Salmeterol was also shown to be more effective than a combination of slow-release theophylline and ketotifen in producing disappearance of nocturnal symptoms, lung function and rescue salbutamol use, during a 2 week period of treatment in 115 patients with nocturnal asthma [5].This large multicentre study was conducted in 24 European Centres, in order to compare the efficacy and tolerability of salmeterol with oral theophylline in the treatment of moderate-to-severe asthma. Subjects and methods SubjectsTwo hundred and forty three patients with moderateto-severe asthma were recruited into the study. Inclusion criteria were: 1) male or female aged 18-70 yrs; 2) symptoms of asthma (dyspnoea, wheeze, cough) for at least 1 year; 3) reversible airway obstruction (forced expiratory volume in one second (FEV1)...

Comparison of anti-inflammatory and clinical effects of beclomethasone dipropionate and salmeterol in moderate asthma

“…Symptoms (wheezing, chest tightness, shortness of breath, cough) were rated on a scale from 0 (none) to 4 (never slept because of asthma) for nighttime symptoms and 0 (none) to 5 (could not perform common daily activities because of asthma) for daytime symptoms, and were added up to give the average daily symptom score [22]. Predrug morning PEF was expressed as % predicted.…”

Comparison between eosinophilic markers in induced sputum and blood in asthmatic patients

“…All patients recorded daily symptom score (range: 0 = no symptoms, to 9 = symptoms preventing from attending common daily activities and from sleeping at night) [ 14], the use of β 2 ‐agonists as required, and morning and evening peak expiratory flow (PEF) on a diary card over a screening period of at least 1 week. Daily PEF maximal amplitude (MA) was calculated as follows: (highest PEF value — lowest PEF value)/mean daily value × 100.…”

Combination Therapy with Inhaled Long‐Acting β2‐Agonists and Inhaled Corticosteroids: A Paradigm Shift in Asthma Management

“…The results of these studies show that salmeterol 42 µg twice/day was significantly more effective than theophylline in improving morning PEF, FEV 1 , and asthma symptoms and reducing nighttime awakenings and need for rescue albuterol after treatment for 2-12 weeks. 64,65 The authors of another study 66 reported significant improvements with salmeterol inhalation powder 50 µg twice/day in the median percentage of nights with no asthma symptoms and no need for rescue albuterol compared with dosage titration of slow-release theophylline; although, no significant differences were noted between treatment groups in PEF, symptoms, or need for rescue albuterol during the day.…”