Regular inhaled salbutamol -: Effect on airway responsiveness to methacholine and adenosine 5′-monophosphate and tolerance to bronchoprotection

被引：17

作者：

Jokic, R ^{[1
]}

Swystun, VA ^{[1
]}

Davis, BE ^{[1
]}

Cockcroft, DW ^{[1
]}

机构：

[1] Univ Saskatchewan, Div Resp Med, Dept Med, Royal Univ Hosp, Saskatoon, SK S7N 0W8, Canada

来源：

CHEST | 2001年 / 119卷 / 02期

关键词：

adenosine 5 '-monophosphate; airway hyperresponsiveness; asthma; beta(2)-agonists; bronchoprotection; methacholine; tolerance;

D O I：

10.1378/chest.119.2.370

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

Objective: Regular treatment with inhaled beta (2)-agonists increases airway responsiveness consistently to indirect bronchoconstrictors (allergen, exercise, hypertonic saline solution, etc) and inconsistently to direct bronchoconstrictors (histamine, methacholine), Studies demonstrating tolerance to beta (2)-agonist bronchoprotection against the indirect bronchoconstrictor adenosine 5'-monophosphate (AMP) have not examined changes in baseline AMP responsiveness. This study assessed the effect of regular salbutamol on AMP and methacholine responsiveness and on tolerance to bronchoprotection. Design: Double-blind, randomized, crossover study. Setting: University hospital bronchoprovocation laboratory. Patients: Fourteen atopic asthmatic subjects with FEV1 > 65% predicted, and methacholine provocative concentration causing a 20% fall in FEV1 (PC20) < 8 mg/mL. Interventions: Salbutamol, 100 <mu>g, and placebo inhalers, mo puffs qid, each for 10 days. Measurements: Methacholine PC20 and AMP PC20 measured 12 h after blinded inhaler after each (eight subjects). Results: There was no difference between placebo and salbutamol treatment in geometric mean methacholine PC20 (0.85 mg/mL vs 0.82 mg/mL, p = 0.86) or AMP PC20 (22 mg/mL vs 17.4 mg/mL, p = 0.21; n = 14), The acute bronchoprotective effect of salbutamol was greater vs AMP than vs methacholine (5.1 doubling concentrations vs 3.5 doubling concentrations, p = 0.06) and loss of protective effect of salbutamol (mean +/- SD) was greater vs AMP than vs methacholine (2.4 +/- 0.33 doubling concentration loss vs 0.8 +/- 0.21 doubling concentration loss, p = 0.008; n = 8), Conclusion: Regular salbutamol (mean +/- SD) treatment did not enhance airway responsiveness to either the indirect bronchoconstrictor AMP or the direct bronchoconstrictor methacholine, Compared to its effect on methacholine, salbutamol had a greater acute protective effect vs AMP and produced greater loss of protection vs AMP when used regularly.

引用

页码：370 / 375

页数：6

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