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

¹ Cardiothoracic Dept, Respiratory Unit, University of Pisa, and ² Laboratory Unit, Cisanello Hospital, Pisa, Italy

CORRESPONDENCE: P.L. Paggiaro, Dipartimento Cardiotoracico, UO Fisiopatologia Respiratoria, Ospedale Cisanello, via Paradisa 2, 56124, Pisa, Italy. Fax: 39 050580124. E-mail: ppaggiaro@qubisoft.it

Keywords: airway inflammation, asthma, induced sputum

Received: November 6, 2000
Accepted January 23, 2002

Inhaled corticosteroids and long-acting ß₂-agonists effectively control asthma symptoms and improve airway function. The effects of beclomethasone were compared with those of salmeterol on markers of eosinophilic inflammation in induced sputum in steroid-naïve asthmatic subjects with moderate asthma.

Fifteen moderate asthmatics were treated with either beclomethasone dipropionate (500 µg b.i.d) or salmeterol (50 µg b.i.d) for 4 weeks, according to a randomised, double-blind, parallel-group study design. All patients underwent spirometry, methacholine test, sputum induction, and blood sampling before and after 2 and 4 weeks of treatment. They also recorded daily symptoms and peak expiratory flow (PEF).

Sputum eosinophils, eosinophil cationic protein (ECP) and eosinophil protein X (EPX), and blood eosinophils, as well as the forced expiratory volume in one second (FEV₁) and morning PEF, significantly improved after beclomethasone but not after salmeterol. PEF variability, the symptom score and rescue ß₂-agonist use significantly improved after both treatments, although the improvement in the symptom score tended to be greater after beclomethasone. After 2 and 4 weeks of beclomethasone treatment, both serum ECP and EPX decreased. With salmeterol, only serum EPX decreased, after 4 weeks. Bronchial hyperresponsiveness to methacholine did not change after either treatment.

The authors conclude that beclomethasone, but not salmeterol, substantially improves airway inflammation in asthma. Beclomethasone also had an overall greater clinical effect, although the improvement in symptoms and peak expiratory flow variability was similar after both treatments.

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