Salmeterol and its relationship to treatment with inhaled corticosteroids

  • Andrew P. Greening
Conference paper


In the context of control of asthma symptoms β2-agonists have a major role. The long-acting inhaled β2-agonists, such as salmeterol, would appear to be extremely valuable, not only in control of night-time and exercise related symptoms but also as an addition to inhaled steroids in patients who continue to have symptoms. In this last context the addition of salmeterol is significantly more effective than doubling or more than doubling the dose of inhaled steroid.


Asthma Control Allergy Clin Immunol Beclomethasone Dipropionate Nocturnal Asthma Asthma Mortality 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Sears MR, Taylor DR, Print CG, et al (1990) Regular inhaled 13-agonist treatment in bronchial asthma. Lancet 336: 1391–6PubMedCrossRefGoogle Scholar
  2. 2.
    van Schayck CP, Dompeling E, van Herwaarden CLA, et al (1991) Bronchodilator treatment in moderate asthma or chronic bronchitis: continuous or on demand? A randomised controlled study. Brit Med J 303: 1426–31PubMedCrossRefGoogle Scholar
  3. 3.
    Spitzer WO, Suissa S, Ernst P, et al (1992) The use of 13-agonists and the risk of death and near death from asthma. N Engl J Med 326: 501–6PubMedCrossRefGoogle Scholar
  4. 4.
    Trembath PW, Greenacre JK, Anderson M, et al (1979) Comparison of four week’s treatment with fenoterol and terbutaline aerosols in adult asthmatics. A double blind crossover study. J Allergy Clin Immunol 63: 395–400Google Scholar
  5. 5.
    Harvey JE, Tattersfield AE (1982) Airway response to salbutamol: effect of regular salbutamol inhalation in normal, atopic and asthmatic subjects. Thorax 37: 280–7PubMedCrossRefGoogle Scholar
  6. 6.
    Wahedna I, Wong CS, Wisniewski AFZ, et al (1993) Asthma control during and after cessation of regular beta2-agonist treatment. Am Rev Respir Dis 148: 707–12PubMedCrossRefGoogle Scholar
  7. 7.
    Bel EH, Zwinderman AH, Timmers MC, et al (1991) The protective effect of a p2-agonist against excessive airway narrowing in response to bronchoconstrictor stimuli in asthma and chronic obstructive lung disease. Thorax 46: 9–14PubMedCrossRefGoogle Scholar
  8. 8.
    Gongora HC, Wisniewski AFZ, Tattersfield AE (1991) A single-dose comparison of inhaled albuterol and two formulations of salmeterol on airway activity in asthmatic subjects. Am Rev Respir Dis 144: 626–9PubMedCrossRefGoogle Scholar
  9. 9.
    Vathenen AS, Knox AJ, Higgins BG, et al (1988) Rebound increase in bronchial responsiveness after treatment with inhaled terbutaline. Lancet i: 544–8Google Scholar
  10. 10.
    Kraan J, Kroeter GH, van der Mark TW, et al (1985) Changes in bronchial hyperreactivity induced by 4 weeks of treatment with anti-asthmatic drugs in patients with allergic asthma: a comparison between budesonide and terbutaline. J Allergy Clin Immunol 76: 628–36PubMedCrossRefGoogle Scholar
  11. 11.
    Kerrebijn KF, van Essen-Zandvliet EEM, Neijens HJ (1987) Effect of long term treatment with inhaled corticosteroids and 0-agonists on the bronchial responsiveness in children with asthma. J Allergy Clin Immunol 79: 653–9PubMedCrossRefGoogle Scholar
  12. 12.
    Cockroft DW, McPharland CP, Britto SA, et al (1993) Regular inhaled salbutamol and airway responsiveness to allergen. Lancet 342: 833–7CrossRefGoogle Scholar
  13. 13.
    Cockroft DW, O’Byrne PM, Swystun VA, et al (1995) Regular use of inhaled albuterol and the allergen-induced late asthmatic response. J Allergy Clin Immunol 96: 44–9CrossRefGoogle Scholar
  14. 14.
    Speizer FE, Doll R, Heaf P (1968) Observations on recent increase in mortality from asthma. Br Med J 1: 335–9PubMedCrossRefGoogle Scholar
  15. 15.
    Speizer FE, Doll R (1968) A century of asthma deaths in young people. Br Med J 3: 245–6PubMedCrossRefGoogle Scholar
  16. 16.
    Gandevia B (1968) The changing pattern of mortality from asthma in Australia. Med J Aust 1: 747–52 and 884–91PubMedGoogle Scholar
  17. 17.
    Inman WHW, Adelstein AM (1969) Rise and fall of asthma mortality in England and Wales in relation to use of pressurised aerosols. Lancet ii: 279–85CrossRefGoogle Scholar
  18. 18.
    Stolley P (1972) Asthma mortality: why the United States was spared an epidemic of deaths due to asthma. Am Rev Respir Dis 105: 883–90PubMedGoogle Scholar
  19. 19.
    Crane J, Pearce N, Flatt A, et al (1989) Prescribed fenoterol and death from asthma in New Zealand, 1981–1983: case control study. Lancet i: 279–85Google Scholar
  20. 20.
    Pearce N, Grainger J, Atkinson M, et al (1990) Case-control study of prescribed fenoterol and death from asthma in New Zealand, 1977–1981. Thorax 45: 170–5PubMedCrossRefGoogle Scholar
  21. 21.
    Grainger J, Woodman K, Pearce N, et al (1991) Prescribed fenoterol and death from asthma in New Zealand, 1981–1987: a further case control study. Thorax 46: 105–11PubMedCrossRefGoogle Scholar
  22. 22.
    Pearce N, Beasley R, Crane J, et al (1995) End of the New Zealand asthma mortality epidemic. Lancet 345: 41–4PubMedCrossRefGoogle Scholar
  23. 23.
    Beasley R, Burgess C, Crane J, et al (1995) The New Zealand asthma mortality epidemic. Clin Sci 88: 14–7PubMedGoogle Scholar
  24. 24.
    Suissa S, Blais L, Ernst P (1994) Patterns of increasing (3-agonist use and the risk of fatal or near-fatal asthma. Eur Respir J 7: 1602–9PubMedCrossRefGoogle Scholar
  25. 25.
    Mullen M, Mullen B, Carey M (1993) The association between beta-agonist use and death from asthma. A meta-analytic integration of case-control studies. JAMA 270: 1842–5PubMedCrossRefGoogle Scholar
  26. 26.
    Cheung D, Timmers MC, Zwinderman AH, et al (1992) The prolonged effects of a long-acting (32-adrenoceptor agonist, salmeterol, on airway hyperresponsiveness in patients with mild asthma. N Engl J Med 327: 1198–203PubMedCrossRefGoogle Scholar
  27. 27.
    Booth H, Fishwick K, Harkawat R, et al (1993) Changes in methacholine induced bronchoconstriction with the long acting beta2-agonist salmeterol in mild to moderate asthmatic patients. Thorax 48: 1121–4PubMedCrossRefGoogle Scholar
  28. 28.
    Giannini D, Carletti A, Dente FL, et al (1995) Tolerance to salmeterol in allergen induced bronchoconstriction. Am J Resp Crit Care Med 151: A39Google Scholar
  29. 29.
    Ramage L, Lipworth BJ, Ingram CG, Cree IA, Dhillon DP (1994) Reduced protection against exercise induced bronchoconstriction after chronic dosing with salmeterol. Resp Med 88: 363–8CrossRefGoogle Scholar
  30. 30.
    Ramage L. Beta2-adrenergic agonists in asthma. MD Thesis, University of Aberdeen, UK (submitted)Google Scholar
  31. 31.
    Castle W, Fuller R, Hull J, et al (1993) The Serevent nationwide surveillance study. Brit Med J 306: 1034–7PubMedCrossRefGoogle Scholar
  32. 32.
    Devoy MAB, Fuller RW, Palmer JBD (1995) Are there any detrimental effects of the use of inhaled long-acting β2-agonists in the treatment of asthma. Chest 107: 1116–24PubMedCrossRefGoogle Scholar
  33. 33.
    Britton MG, Earnshaw JS, Palmer JBD (1992) A twelve month comparison of salmeterol with salbutamol in asthmatic patients. Eur Respir J 5: 1062–7PubMedGoogle Scholar
  34. 34.
    Lundback B, Rawlinson DW, Palmer JBD (1993) Twelve month comparison of salmeterol and salbutamol as dry powder formulations in asthmatic patients. Thorax 48: 148–53PubMedCrossRefGoogle Scholar
  35. 35.
    Pearlman DS, Chervinsky P, LaForce C, et al (1992) A comparison of salmeterol with albuterol in the treatment of mild to moderate asthma. N Engl J Med 327: 1420–5PubMedCrossRefGoogle Scholar
  36. 36.
    D’Alonzo GE, Nathan RA, Henochowicz S, et al (1994) Salmeterol xinofoate as maintenance therapy compared with albuterol in patients with asthma. JAMA 271: 1412–6PubMedCrossRefGoogle Scholar
  37. 37.
    Dahl R, Earnshaw JS, Palmer JB (1991) Salmeterol: a four week study of a long-acting beta-adrenoceptor agonist for the treatment of reversible airways disease. Eur Respir J 4: 1178–84PubMedGoogle Scholar
  38. 38.
    Britton MG, Earnshaw JS, Palmer JB (1992) A twelve month comparison of salmeterol with salbutamol in asthmatic patients. Eur Respir J 5: 1062–67PubMedGoogle Scholar
  39. 39.
    Fitzpatrick MF, MacKay T, Driver H, Douglas NJ (1990) Salmeterol in nocturnal asthma: a double-blind, placebo controlled trial of long-acting inhaled (β2-agonist. Br Med J 301: 1365–68CrossRefGoogle Scholar
  40. 40.
    Muir JF, Bertin L, Georges D (1992) Salmeterol versus slow-release theophylline combined with ketotifen in nocturnal asthma: a multicentre trial. Eur Respir J 5: 1197–1200PubMedGoogle Scholar
  41. 41.
    Fjellbirkeland L, Gulsvik A, Palmer JBD (1994) The efficacy and tolerability of inhaled salmeterol and individually dose-titrated, sustained-release theophylline in patients with reversible airways disease. Respir Med 88: 599–607PubMedCrossRefGoogle Scholar
  42. 42.
    Matusiewicz SP, Dewar M, Howie SEM, Grenning AP (1993) Salmeterol therapy for severe nocturnal asthma does not influence blood lymphocyte and monocyte cell surface activation. Am Rev Respir Dis 147: A980Google Scholar
  43. 43.
    Green CP, Price JF (1992) Prevention of exercise induced asthma by inhaled salmeterol xinofoate. Arch Dis Child 67: 1014–17PubMedCrossRefGoogle Scholar
  44. 44.
    Kemp JP, Dockhorn RJ, Busse WW, Bleeker ER, van As A (1994) Prolonged effect of inhaled salmeterol against exercise-induced bronchospasm. Am J Resp Crit Care Med 150: 1612–1615PubMedGoogle Scholar
  45. 45.
    International consensus report on the diagnosis and management of asthma (1992) Clin Exp Allergy 22 [Suppl]: 1–72Google Scholar
  46. 46.
    Guidelines on the management of asthma (1993) Thorax 48 [Suppl]: S 1–24CrossRefGoogle Scholar
  47. 47.
    Workshop: Pharmacological treatments of bronchial asthma II. (1993) 178–9. Läkemedelsverket, Medical Products Agency, Uppsala, SwedenGoogle Scholar
  48. 48.
    Toogood JH, Lefcoe NM, Haines DSM, et al (1977) A graded dose assessment of the efficacy of beclomethasone dipropionate aerosol for severe chronic asthma. J Allergy Clin Immunol 59: 298–308PubMedCrossRefGoogle Scholar
  49. 49.
    Gaddie J, Petrie GR, Reid IW, et al (1973) Aerosol beclomethasone dipropionate: a dose-response study in chronic bronchial asthma. Lancet ii: 280–81CrossRefGoogle Scholar
  50. 50.
    Hummel S, Lehtonen L and Study Group (1992) Comparison of oral-steroid sparing by high-dose and low-dose inhaled steroid in maintenance treatment of severe asthma. Lancet 340: 1483–87CrossRefGoogle Scholar
  51. 51.
    Sears MR, Taylor DR, Print CG, et al (1992) Increased inhaled bronchodilator vs increased inhaled corticosteroid in the control of moderate asthma. Chest 102: 1709–15PubMedCrossRefGoogle Scholar
  52. 52.
    Greening AP, Ind PW, Northfield M, et al (1994) Added salmeterol versus higher-dose corticosteroid in asthma patients with symptoms on existing inhaled corticosteroid. Lancet 344: 219–24PubMedCrossRefGoogle Scholar
  53. 53.
    Woolcock A, Lundback B, Ringdal N, Jacques LA (1996) Comparison of addition of salmeterol to inhaled steroids with doubling of the dose of inhaled steroids. Am J Respir Crit Care Med 153: 1481–88PubMedGoogle Scholar
  54. 54.
    Tattersfield AE, Wilding P, Thompson-Coon J, et al (1996) Efficacy and safety of long term treatment with salmeterol in adults with asthma. Am J Respir Crit Care Med 153: A66Google Scholar

Copyright information

© Springer-Verlag/Wien 1998

Authors and Affiliations

  • Andrew P. Greening
    • 1
  1. 1.Respiratory Medicine ClinicWestern General HospitalEdinburghUK

Personalised recommendations