SEPARATE AND COMBINED EFFECTS OF CORTICOSTEROIDS AND BRONCHODILATORS ON AIR-FLOW OBSTRUCTION AND AIRWAY HYPERRESPONSIVENESS IN ASTHMA

JB WEMPE, DS POSTMA, N BREEDERVELD, D ALTINGHEBING, TW VANDERMARK, GH KOETER

Research output: Contribution to journalArticleAcademicpeer-review

20 Citations (Scopus)

Abstract

We have investigated separate and interactive effects of corticosteroids and bronchodilators on airflow obstruction and airway hyperresponsiveness. Twelve allergic subjects with asthma were treated in a double-blind, crossover, randomized study with budesonide, 1.6 mg daily for 3 weeks, prednisone, 40 mg daily, for 8 days, and placebo. After each period, dose-response curves were measured on 4 study days with doubling doses of salbutamol, ipratropium, a combination of salbutamol and ipratropium, and placebo until a plateau in FEV1 was reached. A histamine challenge was then performed, and the provocation concentration causing a 20% fall in FEV1 (PC20) was calculated. The budesonide and prednisone regimens were equipotent. FEV1 was 81.2% of predicted after budesonide, 81.0% predicted after prednisone, and 67.5% predicted after placebo, bronchodilatation thus being 13.7% predicted (budesonide) and 13.5% predicted (prednisone). PC20 improved with 2.17 doubling concentrations (DCs) after budesonide, and 1.86 DCs after prednisone, compared with that of placebo. Salbutamol caused stronger bronchodilatation than ipratropium (26.2% versus 14.7% predicted) and a better protection against histamine challenge (3.95 versus 1.12 DC). The effects of corticosteroids and bronchodilators on FEV1 and PC20 were, in general, additive. This study emphasizes different modes of action on both airflow obstruction and airway hyperresponsiveness by corticosteroids and bronchodilators, and it demonstrates no enhancement of bronchodilator action by corticosteroids.

Original languageEnglish
Pages (from-to)679-687
Number of pages9
JournalJournal of Allergy and Clinical Immunology
Volume89
Issue number3
Publication statusPublished - Mar-1992

Keywords

  • AIRWAY HYPERRESPONSIVENESS
  • ASTHMA
  • CORTICOSTEROIDS
  • BRONCHODILATORS
  • DOSE-RESPONSE CURVES
  • BRONCHIAL RESPONSIVENESS
  • IPRATROPIUM BROMIDE
  • BECLOMETHASONE DIPROPIONATE
  • FLOW OBSTRUCTION
  • BETA-AGONISTS
  • SALBUTAMOL
  • HISTAMINE
  • LUNG
  • PREDNISOLONE

Cite this