Am. J. Respir. Crit. Care Med., Vol 155, No. 1, 01 1997, 104-108.
Inhaled salmeterol or oral theophylline in nocturnal asthma?
C Selby, HM Engleman, MF Fitzpatrick, PM Sime, TW Mackay and NJ Douglas
Respiratory Medicine Unit, Department of Medicine (RIE), University of Edinburgh, Royal Infirmary, Scotland, United Kingdom.
Nocturnal cough and wheeze are common in asthma and often treated with
beta2 agonists or theophyllines. As nocturnal asthma and these therapies
may affect sleep and cognition, we compared 50 microg salmeterol inhaled
every 12 h with individually dose-titrated sustained- release oral
theophylline on sleep quality and cognitive performance in 15 patients with
stable nocturnal asthma (overnight peak expiratory flow rate [PEFR] fall
> or = 15%, > or = 1 asthmatic awakening/week) using a double-blind,
double-dummy, crossover design with 14-d therapy limbs. Cognitive testing
and polysomnography were performed on Nights 13 and 14. Trough plasma
theophylline concentration after Night 14 on theophylline was median 11.1
(interquartile range 8.3, 15.2) microg/ml. Overnight PEFR falls were
similar [salmeterol 2.3 (0, 10.6), theophylline 3.5 (-0.3, 9.6)%, p = 0.4]
but on salmeterol there were more nights without awakenings [median
difference 1 (0, 2), p < 0.01], fewer nocturnal arousals [difference -3
(-7, 2) h(-1), p < 0.05] and improved quality of life (p = 0.05). Sleep
architecture did not otherwise differ. Visual vigilance improved on
salmetrol (p < 0.05), but otherwise daytime cognition was unaffected.
There was no patient preference for either therapy. Hence in patients with
nocturnal asthma, we demonstrate no major clinical advantage, but a small
benefit in sleep quality, quality of life, and daytime cognitive function
with salmeterol.
