Inhalation Of Salmeterol Research Articles

The Efficacy, Tolerance and Acceptance of a New Fixed-Dose Salmeterol and Fluticasone Propionate Dry-Powder Inhaler—Salflumix Easyhaler® in COPD Patients in the Daily Clinical Practice

The efficacy of the fix-dose salmeterol/fluticasone propionate combination in chronic obstructive pulmonary disease (COPD) was only shown for the original product. This investigator-initiated study aimed to prove the efficacy and safety of Salflumix Easyhaler®, a second-entry product (dry-powder inhaler) in a real-life setting. The efficacy of the therapy was assessed in 440 COPD outpatients (36.1% classified as C&D groups according to GOLD) using the COPD assessment test (CAT) and the modified Medical Research Council (mMRC). During 86 ± 30 days, the frequency of COPD with a big and very big impact on life (CAT > 20 pts); and high scores of dyspnea (mMRC ≥ 2) decreased from 60.7% and 57.5% at I visit to 15.2% and 22.6% at III visits, respectively (p < 0.001). There was a greater improvement in newly diagnosed patients than those who switched from other devices due to insufficient disease control or patient dissatisfaction with the used inhaler. Patients’ satisfaction was scored 3.2–3.5 in a 4 pts scale. Physicians scored the burden related to the use of Salflumix Easyhaler® as very low. Adherence exceeded 90%. This study supports effectiveness, satisfaction, and convenience with the use of this new product in COPD, and shows that ICS-containing DPI therapy is still improperly prescribed for patients with a low risk of COPD exacerbation in real-life settings.

Clinical Effect of Salmeterol and Fluticasone Powder Inhalation Combined with Aminophylline Injection in the Treatment of Senile Bronchial Asthma

Clinical Effect of Salmeterol and Fluticasone Powder Inhalation Combined with Aminophylline Injection in the Treatment of Senile Bronchial Asthma

The response variability of the asthma patients to the standard pharmacotherapy

Background. The aim of this study was to analyse the group of patients with asthma, who prefer to use short-acting anticholinergics (SAMA) for relief of asthma attacks. At the same time, these patients are prescribed inhaled glucocorticosteroids (ICS) in combination with long-acting P2-agonists (LABA) as a basic therapy according to the standards. Tha aim. To study the cause of low efficacy of LABA in patients with asthma who do not have a sufficient response to SABA, as well as the probability of reducing of bronchial obstruction with LAMA. Materials and methods. 12 non-smoking adults with moderate to severe asthma (III-IV stage of GINA), receiving medium or high doses of ICS in combination with LABA as a basic therapy without adequate control over asthma symptoms were included in the study. First group of patients showed the efficacy of salbutamol (FEV1 reversibility was more than 12% and more than 200 ml after 400 ^g of salbutamol) and ipratropium bromide (SABA+SAMA+). Second group included patients with low response to salbutamol and positive test (FEVt reversibility) with ipratropium bromide (SABA-SAMA+). Spirometry was performed at baseline point and in 5, 10, 15, 30, 60, 120 and 240 min after inhalation of bronchodilator (salmeterol 50 ^g, formoterol 12 ^g and tiotropium bromide 18 ^g in the different days). Results. It was shown that SABA-SAMA+ phenotype asthma patients demonstrated low response to LABA: FEV1 increased up to 7.64±1.67%, 156.0±16.0 ml after salmeterol inhalation and up to 9.4±5.8%, 166.7±103.1 ml after formoterol inhalation (compared with a group of SABA+SAMA+, where the response to salmeterol was 20.81±2.42%, 551.43±93.94 ml and the response to formoterol was 30.21±6.75%, 718.57±140.78 ml, p

The application of preoperative pulmonary function and FeNO test in patients with chronic rhinosinusitis

Objective: To explore the application of lung function and exhaled nitric oxide in the evaluation of patients with chronic rhinosinusitis(CRS) with or without polyps who denied bronchial asthma history and planned to undergo endoscopic sinus surgery. Method: Two hundred and thirty-two patients with CRS during April 2016 to April 2018 in our hospital were recruited in this study. All patients accepted lung function and exhaled nitric oxide test before surgery to evaluate whether accompanied with asthma, improvements after standardized drug therapy in patients with asthma. SpO₂, Ppeak and PETCO₂ were monitored and recorded during surgery. Postoperative symptoms of wheezing, shortness of breath, chest tightness and cough were also observed and recorded. Result: ① Of the 232 patients, 18 patients were diagnosed as bronchial asthma, with a positive rate of 7.8%. 17 cases had positive results in bronchodilation test, 1 case was negative whose PEF improvement rate was 40.4%; The mean FeNO of the 18 patients was 46 ppb, of which 16 patients whose FeNO was over 25 ppb; The mean FeNO of 40 cases with normal pulmonary function was over 25ppb, of which 4 cases' FeNO were over 50 ppb;② 232 patients' intraopertive anesthesia monitor showed that SpO₂ were greater than 95%, Ppeak were less than 35 cmH₂O, PETCO₂ were greater than 35 mmHg; ③ Mild dyspnea occurred in a patients diagnosed as asthma the next morning after surgery. The auscultation was scattered in the wheezing sound, and the symptoms were relieved in 10 minutes after inhalation of salmeterol. Conclusion: Routine screening for lung function and FeNO and standardized perioperative treatment in patients with CRS before nasal endoscopy is useful.

A 12‐week, randomized, parallel‐group, proof‐of‐concept study of tulobuterol patch and salmeterol inhaler as add‐on therapy in adult‐onset mild‐to‐moderate asthma

Patch formulation of tulobuterol has been used in asthma treatment as a long-acting β2 -agonist (LABA) through sustained skin absorption. Its treatment efficacy, especially in small airways, remains poorly understood. The study aim was to investigate LABA add-on effects of tulobuterol patch (TP) and salmeterol inhaler (SA) on pulmonary function, asthma control and health status. Patients who had adult-onset under-control asthma, despite taking inhaled corticosteroids, were enrolled in a randomized, open-label, parallel-group, proof-of-concept study of 12-week add-on treatment with TP (n=16) or SA (n=17). Spirometry, impulse oscillometry (IOS), exhaled nitric oxide levels, and clinical questionnaires of asthma control, health status (St. George's Respiratory Questionnaire: SGRQ), and symptoms were evaluated every 4weeks. Add-on treatment of SA significantly improved the spirometric indices of small airway obstruction (forced expiratory flow between 25% and 75% of FVC: FEF25-75 , and maximum expiratory flow at 25% of FVC: MEF25 ) and IOS indices of whole respiratory resistance (resistance at 5Hz) as compared to TP. In intra-group comparisons, add-on treatment of TP improved the scores of the asthma control test and the total SGRQ, as well as the symptom and impact components of the SGRQ. SA add-on treatment improved FEV1 and IOS parameters of resistance at 20Hz and reactance at 5Hz. Neither of the treatments improved exhaled nitric oxide levels. In conclusion, add-on treatment of TP improved asthma control and health status, whereas SA improved pulmonary function measures associated with large and small airway involvement among patients with adult-onset mild-to-moderate asthma.

Difference of the treatment response of the different clinical COPD phenotypes to inhaled salmeterol and fluticasone

Objective To compare the treatment responses of the inhaled salmeterol and fluticasone (50/500 μg) for three months in the different clinical phenotypes of chronic obstructive pulmonary diseases (COPD) which were chronic bronchitis phenotype and emphysema phenotype and to explore the difference of the treatment responses. Methods To enroll and follow up the stable COPD patients from outpatient department who received the treatment of inhaled salmeterol and fluticasone (50/500 μg). Patients with low attenuation area (LAA, the density on CT scan <-950 HU) ≥15% of the while lung area% (LAA%) were defined as emphysema group, while patients with LAA%<15% were defined as chronic bronchitis group. All the subjects received lung function test before and after three-month treatment. Results Totally, 84 patients (49 male and 35 female patients) with stable COPD were enrolled with an average age (61.04±9.23) years old, 30 patients in emphysema group and 54 patients in chronic bronchitis group. Before treatment, forced expiratory volume in one second (FEV1)% predicted value and residual volume (RV)% predicted value in emphysema group were lower than those of chronic bronchitis group (P=0.04 and P=0.01), while inspiratory capacity (IC)% predicted value was higher than that of chronic bronchitis group (P=0.02). After three-month salmeterol and fluticasone inhalation treatment, FEV1 and RV were improved in both groups, but FEV1 and RV in chronic bronchitis group were improved more significantly than those of emphysema group (P=0.02 and P=0.03). Conclusions The treatment responses of different clinical phenotypes of COPD to inhalation of combination of salmeterol and fluticasone were different, chronic bronchitis phenotype had better treatment response compared to emphysema phenotype. Key words: Pulmonary disease, chronic obstructive/DT/PP; Bronchitis, chronic/DT/PP; Pulmonary emphysema/DT/PP; Glucocorticoids/AA/AD; Respiratory function tests

Inhaled Salmeterol Induces Salivary Alpha Amylase Activity in Healthy Subjects

FEBRUARY 2015 AB4 Abstracts S A T U R D A Y 12 Inhaled Salmeterol Induces Salivary Alpha Amylase Activity in Healthy Subjects Andrea A. Pappalardo, MD, Sherlyana Surja, MD, Caitlin M. Campion, Sarah J. Aldrich, James N. Moy, MD; Asthma and Allergy Center, Bloomingdale, IL, Rush University Medical Center, Chicago, IL, John H. Stroger Hospital of Cook County, Chicago, IL. RATIONALE: Salivary alpha-amylase (sAA) secretion is an indirect method of measuring beta-receptor activation. Increases in sAA are seen in isoproterenol-infused mice (attenuated by beta-receptor antagonists) and in humans under physical or mental stress. We previously demonstrated that albuterol given by inhalation increases sAA (peaking at 15 minutes) in healthy volunteers and patients with asthma. We hypothesized that inhaled salmeterol, but not the anticholinergic ipratropium, will induce sAA secretion. METHODS: Five healthy volunteers were enrolled. Spirometry was performed; and sAA, blood pressure and heart rate were collected at baseline and at 15, 30, 60 and 120 minutes after inhalation of fluticasonesalmeterol HFA (90 mcg/42 mcg). Two weeks later, two of the subjects repeated the protocol after inhaling ipratropium (34mcg). Three additional subjects performed spirometry maneuvers alone to confirm stability of sAA during forced expiratory maneuvers. RESULTS: Baseline sAAwas 143651 (U/mL6SEM) , which increased after salmeterol inhalation to 190657, 230668, 2766100, and 239670 at 15, 30, 60, and 120minutes, respectively; peaking at 60minutes (p<0.05 at 60 and 120 minutes; ANOVA). sAA did not change after ipratropium inhalation or spirometry alone. FEV1 did not change from baseline after inhalation of salmeterol or ipratropium in these healthy volunteers. No significant changes in blood pressure and heart rate were observed in any group. CONCLUSIONS: Salmeterol induces sAA in healthy subjects, but peaks later than albuterol, consistent with its pharmacokinetic properties. These findings reinforce the concept that sAA is a surrogate marker for beta-2receptor activation and may be useful in assessing tachyphylaxis or unresponsiveness to beta-2-agonists.

Salmeterol Xinafoate.

Salmeterol xinafoate is a potent and a long-acting β2-adrenoceptor agonist. It is prescribed for the treatment of severe persistent asthma and chronic obstructive pulmonary disease. Different methods were used to prepare (R)-(-)-salmeterol such as: mixing a sample of 4-benzyloxy-3-hydroxymethyl-ω-bromoacetophenone with sodium lauryl sulfate and the mixture was added to the microbial culture of Rhodotorula rubra, treatment of p-hydroxyacetophenone with Eschenmoser's salt and carbonate exchange resin followed by a sequence of supported reagents and scavenging agents or via Rh-catalyzed asymmetric transfer hydrogenation. The enantioselective synthesis of (S)-salmeterol was achieved via asymmetric reduction of the azidoketone 4 by Pichia angusta yeast. Physical characteristics of salmeterol xinafoate were confirmed via: X-ray powder diffraction pattern, thermal analysis and UV, vibrational, nuclear magnetic resonance, and mass spectroscopical data. Initial improvement in asthma control may occur within 30 min following oral inhalation of salmeterol in fixed combination with fluticasone propionate. Clinically important improvements are maintained for up to 12 h in most patients. It is extensively metabolized in the liver by hydroxylation, thus increased plasma concentrations may occur in patients with hepatic impairment.

Evaluation on therapeutic effects of tiotropium combined with salmeterol and fluticasone in treatment of stable COPD patients of group C

Objective To investigate the therapeutic effects of combination treatment of tiotropium plus salmeterol and fluticasone in the treatment of stable chronic obstructive pulmonary disease (COPD) patients of group C.Methods 60 subjects with stable COPD in group C classified by combined COPD assessment,were randomly divided into a treatment group (n=30) and a control group (n=30).The treatment group was treated with tiotropium(1 8 μ g,inhalation,once daily) plus salmeterol and fluticasone (50,500 μ g,inhalation,twice a day) and the control group was treated only with ipratropium bromide and albuterol aerosol according to the needs.The exercise tolerance and lung function were measured before and 8 weeks after the treatment respectively.Results 8 weeks after the treatment,there were improvements of 6 minute walk test compared with baseline and the control group,significantly greater improvements in the FVC,FEV1 and FEV1％ pred were seen in the treatment group at all time points(P＜O.05).FVC,FEV1 and FEV1％ pred 8 weeks after treatment were higher than those before treatment in both two groups(P＜O.05),but there was a significant difference between the treatment group and the control group (P＜O.05).Conclusion Combination treatment with tiotropium,salmeterol and fluticasone inhalation has greater therapeutic benefits than ipratropium bromide or albuterol aerosol inhalation alone in stable COPD patients of group C. Key words: Chronic obstructive pulmonary disease (COPD); Tiotropium; Salmeterol/Fluticasone

Fluticasone impact on airway dendritic cells in smokers: a randomized controlled trial

BackgroundMyeloid Dendritic cells are key drivers of inflammation in smoke-related lung diseases, whereas plasmacytoid DCs play a crucial role in the defense against infections. Effects of inhaled corticosteroids (ICS) on airway DCs in smokers are unknown.MethodsIn this randomized, double-blind, placebo-controlled clinical trial, 45 active cigarette smokers inhaled placebo, fluticasone or fluticasone plus salmeterol twice daily for 4 weeks. Bronchoalveolar lavage fluid DCs were analyzed using four-color flow cytometry before and after the inhalation period. In addition, fluticasone effects were tested on T-cell proliferation in co-cultures with blood myeloid DCs from smokers.ResultsInhalation of fluticasone plus salmeterol, but not fluticasone alone or placebo, reduced endobronchial concentrations of myeloid DCs (median decrease: 24%), macrophages (median decrease: 26%) and neutrophils (median decrease: 76%). In contrast, fluticasone reduced plasmacytoid DC concentrations independently of salmeterol. There were no changes in the expression of function-associated surface molecules on myeloid DC (such as CD1a, Langerin, BDCA-1, CD83 or CCR5) in all groups after treatment. Fluticasone (either alone or in combination with salmeterol) suppressed T-cell proliferation in co-cultures with blood myeloid DCs from smokers.ConclusionsResistance to ICS monotherapy in smokers might in part be due to lacking effects on airway myeloid DCs, whereas the increased risk for infections during ICS therapy could be attributable to a reduction in plasmacytoid DCs. Combination therapy of fluticasone with salmeterol is associated with a reduction in airway myeloid DCs, but also airway macrophages and neutrophils.Trial registrationRegistered at ClinicalTrials.gov (identifier: NCT00908362) and the European Clinical Trial Database, EudraCT (identifier: 2009-009459-40).

Lactic acidosis following intentional overdose by inhalation of salmeterol and fluticasone

Salmeterol, a long-acting β2-adrenergic receptor agonist used for the treatment of asthma and chronic obstructive pulmonary disease, has an adverse effects profile that is similar to that of salbutamol and other β2-agonists. We report a sympathomimetic syndrome with metabolic acidosis and hyperlactatemia after intentional inhalation of salmeterol in a suicide attempt. A 16-year-old female patient was admitted to the emergency department approximately 2 hours after having inhaled 60 puffs of a combination of salmeterol xinafoate 25 μg and fluticasone propionate 50 μg. She presented in an anxious state with complaints of palpitations and chest pain. The electrocardiogram demonstrated sinus tachycardia and ST-segment depression in the inferior and anterolateral leads. Laboratory findings showed hypokalemia, hypophosphatemia, and lactic acidosis. Cardiac troponin I and creatine kinase MB remained within the normal range. Treatment was supportive and included intravenous fluids and cautious potassium supplementation. The next day, electrocardiographic and laboratory findings returned to normal. We hypothesize that stimulation of β2-adrenergic receptors by inhalation of salmeterol caused this patient's lactic acidosis. This observation is consistent with the hypothesis that the hyperlactatemia observed during asthma attacks is due in part to the administration of high doses of β2-agonists. Salmeterol overdose by inhalation appears to be sufficient to cause lactic acidosis.

The clinical observation of fluticasone salmeterol inhaler combined with salbutamol inhalation of oxygen-driven treatment of chronic obstructive pulmonary disease with acute exacerbation

Objective To observe the clinical efficacy of fluticasone salmeterol inhaler combined with salbutamol inhalation of oxygen-driven treatment of chronic obstructive pulmonary disease with acute exacerbation. Methods 60 patients of chronic obstructive pulmonary disease with acute exacerbation ,randomly divided into observation and control groups of 30 patients each. The control group on the basis of conventional treatment with salmeterol plus flutica sone inhalation powder compound and the oxygen-driven albuterol inhalation aerosol liquid, the other group by conventional therapy based on the use of oxygen-driven albuterol inhalation aerosol solution, then compare the clinical curative effects. Results There were 18 examples excellencely, i0 examples improve, 2 examples ineffective of observation group with total effective rate 93.3% ;9 examples excellencely, 11 examples improve, 10 examples ineffective of control group with total effective rate 66.7%. The contrast of total effective power with the two groups exists the staffstical significance （ X2 = 4.60,P 〈 0.05 ） o In the observation group, FEV1 and FVC of post-treatment, were better than pretherapy and post-treatment of control group （ t = 2. 629,2. 649,2.064,2.051, P 〈 0. 05 ）. Conclusion Salmeterol and fluticasone propionate inhalation powder hybrid atomizing inhalation of salbutamol effective than salbutamol alone. Key words: Pulmonary disease, chronic obstructive ; Administration, inhalation; Salmeterol, fluticasone ; Salbutamol

Urine Concentrations of Inhaled Salmeterol and its Metabolite a-Hydroxysalmeterol in Asthmatic and Non-Asthmatic Subjects

Salmeterol is a long-acting beta2-agonist, which is on the WADA prohibited list, but can be used by athletes in therapeutic doses by inhalation. The prohibited list, however, contains no urinary threshold for salmeterol, which gives athletes the opportunity to inhale unlimited doses of salmeterol. In doping controls, metabolites may be used as markers for misuse of substances. No studies have determined urine concentrations of α-hydroxysalmeterol, the metabolite of salmeterol. Furthermore, the metabolism and excretion of salmeterol may vary between asthmatics and nonasthmatics. We determined the serum and urinary concentrations of salmeterol and its metabolite α-hydroxysalmeterol after inhalation of 100 μg salmeterol in ten asthmatics and ten non-asthmatics. Blood samples were collected at baseline and ½, 1, 2, 3, 4 and 6 hours after the administration of salmeterol. Urine samples were collected at baseline and 4, 8 and 12 hours after administration. The urinary concentration of salmeterol following enzymatic hydrolysis of the glucuronide fraction was 0.38 ± 0.26 ngmL-1 in asthmatics and 0.38 ± 0.22 ngmL-1 in non-asthmatics, 4 hours after inhalation. The highest median serum concentration (Cmax) was 0.07 ± 0.03 ngmL-1 in asthmatics after 30 minutes (Tmax) and 0.06 ± 0.03 ngmL-1 in non-asthmatics. No statistical differences were found in Cmax or Tmax of salmeterol between asthmatics or non-asthmatics in neither the serum nor urine samples. The highest median urinary concentration of α-hydroxysalmeterol following enzymatic hydrolysis of the glucuronide fraction was 2.86 ± 1.75 ngmL-1 in asthmatics, 4 hours after inhalation of salmeterol. In non-asthmatics, it was 2.73 ± 2.08 ngmL-1. The asthmatics had a significantly (p<0.05) higher concentration after 12 hours compared with non-asthmatics. In doping control, α-hydroxysalmeterol may be a more suitable marker for excessive use of inhaled salmeterol, due to its higher concentration in urine.

Exophytic Plaques, Blisters, and Mouth Ulcers—Quiz Case

A 36-year-old woman presented with a painful and pruritic eruption on both feet. She had a history of asthma, allergic rhinitis, and chronic sinusitis and had been treated atvarioustimeswithfexofenadinehydrochloride,mometasone furoate nasal spray, hydroxyzine hydrochloride, diphenhydramine hydrochloride, albuterol sulfate, montelukast sodium, fluticasone propionate, and salmeterol inhalation powder. She reported intermittent episodes of unilateral lower leg edema associated with pruritus, which had been treated with diphenhydramine in the past. The physical examination showed lower extremity swelling with retiform erythematous and hyperpigmented patches with central vesiculation limited to the dorsal feet (Figure1). Dorsalis pedis pulses were present. Initial laboratory studies revealed an elevated white blood cell (WBC) count of 14 900 cells/μL with 47% eosinophilia. The erythrocyte sedimentation rate was 92 mm/h, and the alkaline phosphatase level was 320 U/L. (To convert WBC count to cells 10 per liter, multiply by 0.001. To convert alkaline phosphatase to microkatals per liter, multiply by 0.0167.) A punch biopsy sample was taken from the right dorsal foot (Figure 2 and Figure 3) What is your diagnosis?

Annular Patches and Plaques on the Scrotum and Buttocks—Quiz Case

A 36-year-old woman presented with a painful and pruritic eruption on both feet. She had a history of asthma, allergic rhinitis, and chronic sinusitis and had been treated atvarioustimeswithfexofenadinehydrochloride,mometasone furoate nasal spray, hydroxyzine hydrochloride, diphenhydramine hydrochloride, albuterol sulfate, montelukast sodium, fluticasone propionate, and salmeterol inhalation powder. She reported intermittent episodes of unilateral lower leg edema associated with pruritus, which had been treated with diphenhydramine in the past. The physical examination showed lower extremity swelling with retiform erythematous and hyperpigmented patches with central vesiculation limited to the dorsal feet (Figure1). Dorsalis pedis pulses were present. Initial laboratory studies revealed an elevated white blood cell (WBC) count of 14 900 cells/μL with 47% eosinophilia. The erythrocyte sedimentation rate was 92 mm/h, and the alkaline phosphatase level was 320 U/L. (To convert WBC count to cells 10 per liter, multiply by 0.001. To convert alkaline phosphatase to microkatals per liter, multiply by 0.0167.) A punch biopsy sample was taken from the right dorsal foot (Figure 2 and Figure 3) What is your diagnosis?

COMPARISON OF ADHERENCE AND EFFICACY BETWEEN INHALED SALMETEROL AND TRANSDERMAL TULOBUTEROL PATCH IN ELDERLY PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISORDER

COMPARISON OF ADHERENCE AND EFFICACY BETWEEN INHALED SALMETEROL AND TRANSDERMAL TULOBUTEROL PATCH IN ELDERLY PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISORDER

Effect of Altitude on the Heart and the Lungs

This review focuses on the effects of altitude exposure from 1 to several days or weeks as occurs in tourists, trekkers, and mountaineers who visit high altitude and normally reside near sea level. We briefly review the acute physiological adjustments and early acclimatization that occur in the cardiovascular system and the lungs of healthy individuals. These ensure life-sustaining oxygen delivery to the tissues despite a reduction in the partial pressure of inspired oxygen between 20% and 60% at 2500 and 8000 m, respectively. One of the acute adjustments, hypoxic pulmonary vasoconstriction (HPV), may be disadvantageous in those with a vigorous response and lead to 2 potentially lethal illnesses, high-altitude pulmonary edema (HAPE) and subacute mountain sickness (SAMS), which we present in more detail. Finally, on the basis of knowledge about the acute physiological adjustments and acclimatization and, when available, a review of the literature, we discuss the high-altitude tolerance of patients with coronary artery disease, congestive heart failure, arrhythmias, systemic hypertension, and pulmonary hypertension. ### Circulation The major effects of acute hypoxia on the heart and lung are shown in Figure 1. Hypoxia directly affects the vascular tone of the pulmonary and systemic resistance vessels and increases ventilation and sympathetic activity via stimulation of the peripheral chemoreceptors.1 Interactions occur between the direct effects of hypoxia on blood vessels and the chemoreceptor-mediated responses in the systemic and pulmonary circulation. Figure 1. Effects of hypoxia on systemic and pulmonary circulation. Unraveling the underlying mechanisms of the hypoxic vasodilatation of systemic arterioles is an active area of research. Several mechanisms appear to regulate local oxygen delivery according to the needs of the tissues2,3; for instance, the release of ATP from red blood cells and the generation of NO by various ways appear to regulate local oxygen delivery according to the needs …

Cost-effectiveness of salmeterol xinafoate/fluticasone propionate combination inhaler in chronic asthma

ABSTRACTObjective: To determine where in the treatment steps recommended by the British Thoracic Society and Scottish Intercollegiate Guidelines Network (BTS/SIGN) Asthma Guideline it is cost-effective to use salmeterol xinafoate/fluticasone propionate combination inhaler (SFC) (Seretide) compared with other inhaled corti­costeroid (ICS) containing regimens (with and without a long acting beta‑2 agonist (LABA)) for chronic asthma in adults and children.Research design and methods: Meta-analyses of percentage symptom-free days (%SFD) were used within a cost-effectiveness model. Time spent in two asthma control health states, ‘symptom-free’ and ‘with-symptoms’ was used as the measure of differential treatment effectiveness. SFC was compared with varying doses of fluticasone propionate (FP) and beclometasone dipropionate (BDP) with or without a separate salmeterol inhaler, and with the budeson­ide/formoterol combination inhaler (BUD/FORM) (Symbicort). Drug costs, non-drug costs and quality adjusted life years (QALY) were incorporated into the analyses. Results are presented as cost per QALY ratios and uncertainty explored using probabilistic sensitivity analysis.Results: Compared with an increased dose of FP in adults, SFC either ‘dominates’ (i.e. cheaper and more effective) FP or the cost per QALY is £6852. The cost per QALYs estimated in sensitivity analyses using BDP costs range from £5679 to £15 997. For children the cost per QALY for SFC 50 Evohaler* compared with an increased dose of FP is £15 739. SFC is similarly clinically effective in improving %SFDs compared with FP plus salmeterol delivered in separate inhalers (mean differences for each dose comparison of –3.9 (low) (with a 95% confidence interval (CI): –12.96; 5.16); 4.10 (medium) (95% CI: –3.01; 11.21); –0.4 (high) (95% CI: –8.88; 8.08)) and BUD/FORM (mean difference of 0.40 (95% CI –3.69; 4.49)) in adults, and a cheaper SFC option is available at all doses (annual cost savings range from £18–£427 per patient). SFC was similarly effective compared with FP plus salmeterol in separate inhalers in children under 12 and also resulted in annual cost savings of between £47 and £77. A number of other comparisons were also made and the results are available as electronic supplementary data.Conclusions: This is the first analysis to estimate the cost-effectiveness of SFC in chronic asthma compared with multiple comparators and based on a systematic identification of relevant trials and data on %SFDs. The findings suggest that for adults and children uncontrolled on BDP 400 μg/day or equivalent it is a cost-effective option to switch to SFC (at an equivalent ICS dose) compared with increasing the dose of ICS. For adults and children aged 12 years and over who have passed this point and are uncontrolled on BDP 800 μg/day or equivalent, switching to SFC remains a cost-effective approach. Where an adult or child requires an ICS and a LABA to be co-prescribed, SFC is a cost-effective option compared with FP or BDP plus salmeterol delivered in separate inhalers. In adults who require combination therapy, SFC is a cost-effective option compared with BUD/FORM.

Addition of Transdermal or Inhaled Long-Acting β 2-Agonists in Adult Asthmatic Patients Treated with Inhaled Corticosteroids: Switchover Study from Tulobuterol Patch to Salmeterol Dry Powder Inhaler

Sixty-four patients with persistent asthma receiving 200 to 800 μ g of fluticasone propionate daily were enrolled in this switchover study. The patients applied a tulobuterol patch 2 mg every 24 hours for 4 weeks followed by inhalation of salmeterol 100 μ g bid for 4 weeks. The mean values for morning and evening peak expiratory flow improved significantly compared with baseline during the 4 weeks of tulobuterol patch treatment. Further improvement was seen on switching to salmeterol treatment, which was significant even in the first week, and continued until the final week of the study. Use of salmeterol alone resulted in a significant increase in the percentage of forced expiratory volume in 1 second %FEV1 from baseline, with 51% of patients feeling that the treatment was effective (vs. 37% on tulobuterol). These data suggest that salmeterol can achieve better control in asthmatic patients after switching from using tulobuterol patches.

More on Life-Threatening Asthma and Salmeterol

To the Editor: Weinberger and Abu-Hasan (Aug. 24 issue)1 report severe asthma in two patients receiving inhaled corticosteroids and salmeterol. Each actuation of the salmeterol inhaler also deliver...