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Influence of Beclomethasone and Salmeterol on the Perception of Methacholine-Induced Bronchoconstriction FREE TO VIEW

Louis-Philippe Boulet; Hélène Turcotte; André Cartier; Joanne Milot; Johanne Côté; Jean-Luc Malo; Michel Laviolette
Author and Funding Information

Affiliations: From Le Centre québécois d'excellence en santé respiratoire; Unité de Recherche, Centre de Pneumologie de l'Hôpital Laval, Université Laval, Sainte-Foy,  From the Service de Pneumologie, Hôpital du Sacré-Coeur, Montréal, Québec, Canada

Louis-Philippe Boulet, MD, FCCP, Hôpital Laval, 2725, Chemin Sainte-Foy, Sainte-Foy, Québec, Canada, G1V 4G5


1998 by the American College of Chest Physicians


Chest. 1998;114(2):373-379. doi:10.1378/chest.114.2.373
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Abstract

Background: Patient evaluation of asthma severity and medication needs is mostly based on respiratory symptoms and may be influenced by changes in perception of bronchoconstriction-induced sensations. However, the influence of asthma medication on the ability to perceive symptoms is still to be documented. This study evaluated the effects of short-term and regular use of salmeterol on the perception of methacholine-induced bronchoconstriction (MIB) in subjects with mild asthma, using inhaled salbutamol on an "as required" basis (n=15), and in subjects with moderate asthma, using daily inhaled beclomethasone (mean daily dose, 640 µg; n=15) in addition to salbutamol to control their asthma.

Methods: Methacholine challenges (MC) were performed at entry into the study, and then before, 1, and 12 h following inhalation of 50 µg of salmeterol or a placebo, after a 15-day baseline period; and after 4 weeks of twice daily use of those treatments. The measurements were then repeated with the alternate treatment after a 15-day washout period. Finally, a last MC was performed after another 15-day washout period. For each MC, the perception score of bronchoconstriction-associated breathlessness at 20% fall in FEV1 (PS20) was evaluated on a modified Borg scale from 0 to 10.

Results: Subjects using regular beclomethasone had a higher baseline PS20 than those using only salbutamol (means: 3.06±0.06 and 2.01±0.07, p=0.0001). Short- and long-term use of salmeterol did not change significantly the PS20 compared with placebo (p>0.05) in either group (with or without corticosteroid). Although there were some intraindividual variations, mean PS20 did not vary significantly throughout the study.

Conclusion: These observations show that the perception of bronchoconstriction-associated breathlessness is not influenced by regular use of salmeterol. Patients using inhaled corticosteroids show a greater perception of MIB.


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