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The Effect of Salmeterol on Nocturnal Symptoms, Airway Function, and Inflammation in Asthma

Monica Kraft; Sally E. Wenzel; Charlotte M. Bettinger; Richard J. Martin
Author and Funding Information

From the Department of Medicine, National Jewish Center for Immunology and Respiratory Medicine, and the Pulmonary and Critical Care Division, University of Colorado Health Sciences Center, Denver


1997 by the American College of Chest Physicians


Chest. 1997;111(5):1249-1254. doi:10.1378/chest.111.5.1249
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Abstract

Study objective: To determine the efficacy of salmeterol alone in a group of patients with moderate asthma with nocturnal worsening of symptoms.

Design: Double-blind, randomized, placebo-controlled crossover study.

Setting: Tertiary care hospital specializing in respiratory diseases.

Participants: Ten patients with nocturnal asthma.

Interventions: Subjects were randomized to salmeterol, 100 µg twice daily, or placebo for 6 weeks with a 1-week washout between treatment periods. Symptoms, nocturnal awakenings, and β2-agonist use were recorded daily. Spirometry was performed at weeks 1 and 6 of each period at bedtime and at 4 AM, and methacholine challenge was performed at 4 AM followed by bronchoscopy with BAL. BAL fluid analysis included cell count and differential count, eosinophil cationic protein, Charcot-Leyden crystal protein, leukotriene B4, and thromboxane B2.

Results: The percentage of nights with awakenings decreased significantly with salmeterol (69.8±8.7% vs 30.6±10.8% for placebo and salmeterol, respectively; p=0.02). The percentage of 24-h days with supplemental inhaled β2-agonist use significantly decreased with salmeterol (85.9±9.4% vs 70.4±10.1% for placebo and salmeterol, respectively; p=0.04). There were no significant differences in bronchial reactivity, 4 AM FEV1, overnight percentage change in FEV1, or indexes of airway inflammation.

Conclusions: Salmeterol alone improves the number of nocturnal awakenings and supplemental 24-h β2-agonist use in nocturnal asthma without significantly altering lung function and airway inflammation.


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