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2023 SEP 16 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- New study results on asthma have been published. According to news reporting [...]

2022 APR 16 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- Investigators publish new report on nanoencapsulation. According to news reporting out of [...]

Background: Inhaled corticosteroids (ICSs) and long-acting [[beta].sub.2-] agonists (LABAs) are used to treat moderate to severe chronic obstructive pulmonary disease (COPD). Objective: To determine whether long-term ICS therapy, with and without LABAs, reduces inflammation and improves pulmonary function in COPD. Design: Randomized, placebo-controlled trial. (ClinicalTrials.gov registration number: NCT00158847) Setting: 2 university medical centers in The Netherlands. Patients: 114 steroid-naive current or former smokers with moderate to severe COPD. Measurements: Cell counts in bronchial biopsies and sputum (primary outcome); methacholine responsiveness at baseline, 6, and 30 months; and clinical outcomes every 3 months. Intervention: Random assignment by minimization method to receive fluticasone propionate, 500 [micro]g twice daily, for 6 months (n = 31) or 30 months (n = 26); fluticasone, 500 [micro]g twice daily, and salmeterol, 50 [micro]g twice daily, for 30 months (single inhaler; n = 28); or placebo twice daily (n = 29). Results: 101 patients were greater than 70% adherent to therapy. Fluticasone therapy decreased counts of mucosal [CD3.sup.+] cells (-55% [95% Cl, -74% to -22%]; P = 0.004), [CD4.sup.+] cells (78% [Cl, -88% to 60%]; P < 0.001), [CD8.sup.+] cells (-57% [Cl, -77% to -18%]; P = 0.010), and mast cells (-38% [Cl, -60% to -2%]; P= 0.039) and reduced hyperresponsiveness (P= 0.036) versus placebo at 6 months, with effects maintained after 30 months. Fluticasone therapy for 30 months reduced mast cell count and increased eosinophil count and percentage of intact epithelium, with accompanying reductions in sputum neutrophil, macrophage, and lymphocyte counts and improvements in [FEV.sub.1] decline, dyspnea, and quality of life. Reductions in inflammatory cells correlated with clinical improvements. Discontinuing fluticasone therapy at 6 months increased counts of [CD3.sup.+] cells (120% [Cl, 24% to 289%]; P = 0.007), mast cells (218% [Cl, 99% to 407%]; P < 0.001), and plasma cells (118% [CI, 9% to 336%]; P = 0.028) and worsened clinical outcome. Adding salmeterol improved [FEV.sub.1] level. Limitations: The study was not designed to evaluate clinical outcomes. Measurement of primary outcome was not available for 24% of patients at 30 months. Conclusion: ICS therapy decreases inflammation and can attenuate decline in lung function in steroid-naive patients with moderate to severe COPD. Adding LABAs does not enhance these effects. Primary Funding Source: Netherlands Organization for Scientific Research, Netherlands Asthma Foundation, GlaxoSmithKline of The Netherlands, University Medical Center Groningen, and Leiden University Medical Center.

Background: Recent analyses have suggested an increased risk for serious asthma-related adverse events in patients receiving long-acting [beta]-agonists. Purpose: To examine whether the incidences of severe asthma-related events (hospitalizations, intubations, deaths, and severe exacerbations) differ in persons receiving salmeterol plus inhaled corticosteroids compared with inhaled corticosteroids alone. Data Sources: The GlaxoSmithKline (Research Triangle Park, North Carolina) database, MEDLINE, EMBASE, CINAHL, and the Cochrane Database of Systemic Reviews (1982 to September 2007) were searched without language restriction. Study Selection: Randomized, controlled trials reported in any language that compared inhaled corticosteroids plus salmeterol (administered as fluticasone propionate/salmeterol by means of a single device or concomitant administration of inhaled corticosteroids and salmeterol) versus inhaled corticosteroids alone in participants with asthma. Data Extraction: Three physicians independently reviewed and adjudicated blinded case narratives on serious adverse events that were reported in the GlaxoSmithKline trials. Data Synthesis: Data from 66 GlaxoSmithKline trials involving a total of 20 966 participants with persistent asthma were summarized quantitatively. The summary risk difference for asthma-related hospitalizations from these trials was 0.0002 (95% CI, -0.0019 to 0.00231; P = 0.84) for participants receiving inhaled corticosteroids plus salmeterol (n = 35 events) versus those receiving inhaled corticosteroids alone (n = 34 events). One asthma-related intubation and 1 asthma-related death occurred among participants receiving inhaled corticosteroids with salmeterol; no such events occurred among participants receiving inhaled corticosteroids alone. A subset of 24 trials showed a decreased risk for severe asthma-related exacerbations for inhaled corticosteroids plus salmeterol versus inhaled corticosteroids alone (risk difference, -0.025 [CI, -0.036 to -0.014]; P Limitations: The included trials involved selected patients who received careful follow-up. Only 26 trials were longer than 12 weeks. Few deaths and intubations limited the ability to measure risk for these outcomes. Conclusion: Salmeterol combined with inhaled corticosteroids decreases the risk for severe exacerbations, does not seem to alter the risk for asthma-related hospitalizations, and may not alter the risk for asthma-related deaths or intubations compared with inhaled corticosteroids alone.

Background: Treatment of moderate or severe chronic obstructive pulmonary disease (COPD) with combinations of inhaled corticosteroids, long-acting [beta]-agonists, and long-acting anticholinergic bronchodilators is common but unstudied. Objective: To determine whether combining tiotropium with salmeterol or fluticasone--salmeterol improves clinical outcomes in adults with moderate to severe COPD compared with tiotropium alone. Design: Randomized, double-blind, placebo-controlled trial conducted from October 2003 to January 2006. Setting: 27 academic and community medical centers in Canada. Patients: 449 patients with moderate or severe COPD. Intervention: 1 year of treatment with tiotropium plus placebo, tiotropium plus salmeterol, or tiotropium plus fluticasone-salmeterol. Measurements: The primary end point was the proportion of patients who experienced an exacerbation of COPD that required treatment with systemic steroids or antibiotics. Results: The proportion of patients in the tiotropium plus placebo group who experienced an exacerbation (62.8%) did not differ from that in the tiotropium plus salmeterol group (64.8%; difference, -2.0 percentage points [95% Cl, -12.8 to 8.8 percentage points]) or in the tiotropium plus fluticasone-salmeterol group (60.0%; difference, 2.8 percentage points [Cl, -8.2 to 13.8 percentage points]), in sensitivity analyses, the point estimates and 95% confidence bounds shifted in the direction favoring tiotropium plus salmeterol and tiotropium plus fluticasone--salmeterol. Tiotropium plus fluticasone--salmeterol improved lung function (P = 0.049) and disease-specific quality of life (P = 0.01) and reduced the number of hospitalizations for COPD exacerbation (incidence rate ratio, 0.53 [Cl, 0.33 to 0.86]) and all-cause hospitalizations (incidence rate ratio, 0.67 [Cl, 0.45 to 0.99]) compared with tiotropium plus placebo. In contrast, tiotropium plus salmeterol did not statistically improve lung function or hospitalization rates compared with tiotropium plus placebo. Limitations: More than 40% of patients who received tiotropium plus placebo and tiotropium plus salmeterol discontinued therapy prematurely, and many crossed over to treatment with open-label inhaled steroids or long-acting [beta]-agonists. Conclusions: Addition of fluticasone-salmeterol to tiotropium therapy did not statistically influence rates of COPD exacerbation but did improve lung function, quality of life, and hospitalization rates in patients with moderate to severe COPD.

In the last two decades, inhaled beta-2 stimulants have been used to treat acute asthma, as well as for chronic treatment and prevention. They are often used in combination with corticosteroids, which have an anti-inflammatory effect. They have a short duration of action, however, and patients with nocturnal asthma must use sustained-release medications. Salmeterol (SM) is a new potent beta-2 agonist that has a long duration of action (12 hours, in single-dose studies). This study compares SM with salbutamol (SB), which is also a beta-2 agonist, but with a short (six-hour) duration of action. In this crossover study, patients inhaled either SM twice daily, or SB four times daily, to see which improved the patient's perception of his asthma (subjective control), whether symptoms clinically improved (objective control), and whether increasing doses were needed to keep symptoms under control (tachyphylaxis). Twelve patients were enrolled in the study; they all had stable asthma and responded, by clinical measure, to SB. Smaller doses (50 micrograms twice daily) of SM controlled asthma symptoms better than 200 micrograms of SB four times daily. Ten of the 12 patients preferred treatment with SM. There was no evidence, in this study, of tachyphylaxis but, the authors caution, 11 of the 12 patients were receiving inhaled corticosteroids, which may have prevented its development. Nonetheless, it is concluded that this drug will produce both good asthma control and less need for additional systemic administration of different anti-asthma drugs in most patients. (Consumer Summary produced by Reliance Medical Information, Inc.)

Introduction Salmeterol, a new long acting β2 agonist, produces bronchodilatation for at least 12 hours in patients with asthma[1-3] and when given in doses of 50 μg twice daily provides [...]

Regular users of salmeterol are at increased risk of non-fatal serious adverse events compared with those using placebo, a Cochrane review has confirmed. An analysis of the data from 26 [...]

CFC-free inhaler containing salmeterol (as xinafoate) 25mcg per metered dose Treatment of reversible airways obstruction (including nocturnal asthma, and prevention of exercise-induced bronchospasm) in patients requiring long-term regular bronchodilator therapy, [...]

PURPOSE: The present study was undertaken to determine whether regular use of salmeterol reduces the emergency effectiveness of albuterol. PATIENTS AND METHODS: Acutely ill asthmatic patients chronically taking salmeterol, and similar patients who were not taking salmeterol, were treated with albuterol, either as three aerosols of 2.5 mg every 20 minutes for 1 hour or two doses of 5.0 mg every 20 minutes. Peak expiratory flow measurements were monitored before and after each treatment. The time to disposition and the number of return visits were also recorded. RESULTS: One hundred fourteen patients, 57 who took salmeterol and 57 who served as control patients, completed the study. Thirty-three patients in each group received the lower dose of albuterol, and 24 were given the larger amount. There were no significant pretreatment differences between the salmeterol and control groups in the severity of symptoms or the degree of airway obstruction. Both albuterol regimens improved peak flow. Responses in the control group and in the salmeterol group were similar (low-dose albuterol increase in peak flow = 49%, control = 35%, P = 0.37; high-dose albuterol increment in peak flow = 43%, control = 41%, P = 0.81). There were no significant differences between the control group and the salmeterol group in the mean length of stay, the proportion of subjects admitted to the hospital, or the number of return visits. CONCLUSIONS: In patients with asthma, chronic use of salmeterol doses not interfere with the effects of standard doses of albuterol for the treatment of acute decompensations. Am J Med. 1999;107:209-213. [C] 1999 by Excerpta Medica, Inc.

Clinical question What is the best step-up therapy for children with asthma that is not controlled with 100 mcg fluticasone twice a day? Bottom line For children with asthma that [...]

Preventing acute exacerbations is a top priority in patients with chronic obstructive pulmonary disease, and physicians can draw on three types of medication and one nonpharmacologic therapy of proven benefit [...]

SALT LAKE CITY -- The combination of inhaled salmeterol and fluticasone propionate is the first-ever drug therapy that has been shown to reduce mortality in patients with chronic obstructive pulmonary [...]

SAN FRANCISCO -- A single daily dose of fluticasone propionate / salmeterol was safe and effective in asthma control, Dr. Paul Dorinsky reported in a poster session at the annual [...]