Am. J. Respir. Crit. Care Med., Volume 161, Number 5, May 2000, 1459-1464

Effects of Terbutaline and Budesonide on Sputum Cells and Bronchial Hyperresponsiveness In Asthma

RUTH E. ALDRIDGE, ROBERT J. HANCOX, D. ROBIN TAYLOR, JAN O. COWAN, MARTI C. WINN, CHRIS M. FRAMPTON, and G. IAN TOWN

Canterbury and Otago Respiratory Research Groups, Christchurch and Dunedin Schools of Medicine, University of Otago, Christchurch, New Zealand

Previous studies have shown that the regular administration of short acting -agonists can be associated with adverse effects on airway caliber and bronchial hyperresponsiveness (BHR) and that this may occur through a proinflammatory mechanism. The aim was to explore possible adverse effects of high-dose -agonist therapy and to assess any adverse interaction with corticosteroids. We undertook a randomized, crossover study to investigate the effects of 6 wk of treatment with regular terbutaline (1 mg four times a day), regular budesonide (400 µg twice a day), combined treatment, and placebo in subjects with mild to moderate asthma. Major endpoints were PD₁₅ saline, PD₂₀ methacholine, and induced sputum differential cell counts. Thirty-four subjects were randomized and 28 completed the study. PD₁₅ saline decreased on terbutaline alone compared with placebo treatment and on combined treatment compared with budesonide alone (mean fold decrease of 0.57 [95% CI = 0.36, 0.90] and 0.65 [95% CI = 0.43, 0.97], respectively). PD₂₀ methacholine was not affected by the use of terbutaline either alone or in combination with budesonide. The percentage of eosinophils in induced sputum increased during terbutaline treatment alone compared with placebo (median 8.3% versus 4.4%, p = 0.049). The addition of terbutaline to budesonide did not affect the percentage of eosinophils compared with budesonide treatment alone. These findings support the hypothesis that short-acting -agonists have a permissive effect on airway inflammation and that when used in high dose there may be an unfavorable interaction with inhaled corticosteroids.

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