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Duration of effect of single-dose inhaled fluticasone propionate on AMP-induced bronchoconstriction

¹ Dept of Pulmonary Diseases, Heart Lung Center Utrecht, University Medical Center Utrecht, the Netherlands. ² GlaxoSmithKline, Research and Development, Greenford, UK

CORRESPONDENCE: J-W.J. Lammers, Dept of Pulmonary Diseases, Heart-Lung Center Utrecht, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands. Fax: 31 302505415. E-mail: j.w.j.lammers@hli.azu.nl

Keywords: adenosine-5'-monophosphate, airway hyperresponsiveness, asthma, exhaled nitric oxide, fluticasone propionate

Received: April 17, 2003
Accepted November 24, 2003

This study was funded by GlaxoSmithKline, UK.

Airway hyperresponsiveness induced by adenosine-5'-monophosphate (AMP) is regarded as a reliable model for allergic asthma and for the evaluation of anti-asthmatic drugs. Single-dose inhaled corticosteroids (ICS) are known to be protective in this model, but the duration of action of these drugs in this model has never been studied.

The duration of ICS protection was determined by administration of single-dose fluticasone propionate (FP; 1,000 µg) up to 26 h before AMP challenge. A randomised, double-blind, placebo-controlled, four-way crossover study was performed in 13 mild asthmatics (mean±sd predicted forced expiratory volume in one second (FEV₁) 98±7%). Each subject received placebo and FP (at 26, 14 or 2 h prior to the AMP challenge). Furthermore, the marker exhaled nitric oxide (eNO) was studied after administration at these time points to investigate whether eNO also demonstrates the duration of action of ICS.

The doubling concentrations difference (DCD) of AMP causing a 20% fall in FEV₁, when FP was administered 26, 14 or 2 h prior to challenge, was significantly increased as compared with placebo: DCD (95% confidence interval) at 26 h, 0.73 (0.20–1.26), p=0.008; 14 h, 1.50 (0.99–2.01), p<0.001; and 2 h, 2.89 (2.37–3.40), p<0.001. However, eNO was not significantly affected at these time points.

In conclusion, a single dose of 1,000 µg inhaled fluticasone propionate protects against adenosine-5'-monophosphate airway hyperresponsiveness up to 26 h after dosing. This study suggests that adenosine-5'-monophosphate challenge can be used as a sensitive marker to study the duration of action of inhaled corticosteroids.

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