DW Cockcroft, VA Swystun and R Bhagat
Department of Medicine, Royal University Hospital, University of Saskatchewan, Saskatoon, Canada.

Regular treatment with salbutamol increases airway responsiveness to allergen but not to methacholine and produces tolerance to the bronchoprotective effect of salbutamol. The current study addresses the effect of inhaled corticosteroid on these aspects of regular beta 2 agonist use. A group of 13 atopic asthmatic subjects free from all asthma medications and remote from allergen exposure were studied. We used a double-blind, random-order, crossover study to compare four 1-wk treatment periods with > or = 1 wk washout: placebo, salbutamol, 200 micrograms four times per day, budesonide, 400 micrograms four times per day, and the combination of salbutamol and budesonide. We measured the methacholine PC20 and the methacholine dose shift produced acutely by 200 micrograms salbutamol after 7 d and the allergen PC15 after 8 d treatment. Blinded medications were withheld for 8 to 10 h before measurements. The methacholine PC20 was not affected by regular salbutamol but increased significantly (p < 0.014) after both budesonide-containing regimens. Neither the dose shift nor its significant reduction by regularly used beta 2 agonist were influenced by the inhaled corticosteroid. The four allergen PC15 values were significantly different from each other. Compared with placebo, the allergen PC15 was 0.6 doubling doses lower after salbutamol (p = 0.021) and 1.3 doubling doses higher after budesonide (p < 0.001); the allergen PC15 was reduced by 0.53 doubling doses from this new baseline (p = 0.039) when salbutamol and budesonide were used together.(ABSTRACT TRUNCATED AT 250 WORDS)

This article has been cited by other articles:

				D. W. Cockcroft and B. E. Davis Magnitude of Bronchoprotection of Albuterol vs Methacholine: Relationship to Baseline Airway Caliber. Chest, August 1, 2006; 130(2): 622 - 623. [Full Text] [PDF]

				D. Giannini, A. Di Franco, E. Bacci, F. L. Dente, M. L. Bartoli, B. Vagaggini, and P. Paggiaro Tolerance to the Protective Effect of Salmeterol on Allergen Challenge Can Be Partially Restored by the Withdrawal of Salmeterol Regular Treatment Chest, June 1, 2001; 119(6): 1671 - 1675. [Abstract] [Full Text] [PDF]

				R. Jokic, V. A. Swystun, B. E. Davis, and D. W. Cockcroft Regular Inhaled Salbutamol : Effect on Airway Responsiveness to Methacholine and Adenosine 5'-Monophosphate and Tolerance to Bronchoprotection Chest, February 1, 2001; 119(2): 370 - 375. [Abstract] [Full Text] [PDF]

				D R Taylor and R J Hancox Interactions between corticosteroids and beta agonists Thorax, July 1, 2000; 55(7): 595 - 602. [Full Text]

				R. E. ALDRIDGE, R. J. HANCOX, D. ROBIN TAYLOR, J. O. COWAN, M. C. WINN, C. M. FRAMPTON, and G. IAN TOWN Effects of Terbutaline and Budesonide on Sputum Cells and Bronchial Hyperresponsiveness In Asthma Am. J. Respir. Crit. Care Med., May 1, 2000; 161(5): 1459 - 1464. [Abstract] [Full Text]

				R. Crapo Guidelines for Methacholine and Exercise Challenge Testing---1999 . THIS OFFICIAL STATEMENT OF THE AMERICAN THORACIC SOCIETY WAS ADOPTED BY THE ATS BOARD OF DIRECTORS, JULY 1999 Am. J. Respir. Crit. Care Med., January 1, 2000; 161(1): 309 - 329. [Full Text]

				D. W. Cockcroft, B. E. Davis, V. A. Swystun, D. Giannini, and P. Paggiaro Salmeterol, Inhaled Corticosteroids, and Tolerance to Allergen Bronchoprotection Chest, November 1, 1999; 116(5): 1497 - 1498. [Full Text] [PDF]

				R J Hancox, J O Cowan, E M Flannery, G P Herbison, C R McLachlan, C S Wong, and D R Taylor Randomised trial of an inhaled beta 2 agonist, inhaled corticosteroid and their combination in the treatment of asthma Thorax, June 1, 1999; 54(6): 482 - 487. [Abstract] [Full Text]

				R. J Hancox, D. A Stevens, I. M Adcock, P. J Barnes, and D R. Taylor Effects of inhaled beta  agonist and corticosteroid treatment on nuclear transcription factors in bronchial mucosa in asthma Thorax, June 1, 1999; 54(6): 488 - 492. [Abstract] [Full Text]

				D. Giannini, E. Bacci, F. L. Dente, A. Di Franco, B. Vagaggini, R. Testi, and P. Paggiaro Inhaled Beclomethasone Dipropionate Reverts Tolerance to the Protective Effect of Salmeterol on Allergen Challenge Chest, March 1, 1999; 115(3): 629 - 634. [Abstract] [Full Text] [PDF]

				P. J. BARNES, S. PEDERSEN, and W. W. BUSSE Efficacy and Safety of Inhaled Corticosteroids . New Developments Am. J. Respir. Crit. Care Med., March 1, 1998; 157(3): S1 - 53. [Full Text] [PDF]

				R. A. Pauwels, C.-G. Lofdahl, D. S. Postma, A. E. Tattersfield, P. O'Byrne, P. J. Barnes, A. Ullman, and The Formoterol and Corticosteroids Establishing Th Effect of Inhaled Formoterol and Budesonide on Exacerbations of Asthma N. Engl. J. Med., November 13, 1997; 337(20): 1405 - 1411. [Abstract] [Full Text] [PDF]

				P. A. Eggleston Are beta -Adrenergic Bronchodilators Safe? Pediatrics, May 1, 1997; 99(5): 729 - 729. [Full Text]