Rapid corticosteroid effect on β2-adrenergic airway and airway vascular reactivity in patients with mild asthma

Mendes, Eliana S.; Horvath, Gabor; Campos, Michael; Wanner, Adam

doi:10.1016/j.jaci.2007.10.038

« Previous Next »The Journal of Allergy and Clinical Immunology
Volume 121, Issue 3 , Pages 700-704, March 2008

Rapid corticosteroid effect on β₂-adrenergic airway and airway vascular reactivity in patients with mild asthma

Eliana S. Mendes, MD
- Division of Pulmonary and Critical Care Medicine, University of Miami Miller School of Medicine, Miami, Fla
- Reprint requests: Eliana S. Mendes, MD, Division of Pulmonary and Critical Care Medicine, University of Miami School of Medicine, PO Box 016960 (R-47), Miami, FL 33101.
Gabor Horvath, MD, PhD
- Division of Pulmonary and Critical Care Medicine, University of Miami Miller School of Medicine, Miami, Fla
- Department of Pulmonology, Semmelweis University School of Medicine, Budapest, Hungary
Michael Campos, MD
- Division of Pulmonary and Critical Care Medicine, University of Miami Miller School of Medicine, Miami, Fla
Adam Wanner, MD
- Division of Pulmonary and Critical Care Medicine, University of Miami Miller School of Medicine, Miami, Fla

Received 29 May 2007; received in revised form 5 October 2007; accepted 25 October 2007. published online 18 December 2007.

Background

Long-term glucocorticoid therapy has been suggested to improve airway and airway vascular smooth muscle responsiveness to inhaled β₂-agonists in patients with asthma.

Objective

We sought to assess whether a single dose of an inhaled glucocorticoid acutely potentiates β₂-adrenergic airway and airway vascular smooth muscle reactivity in asthma.

Methods

In 10 asthmatic and 10 healthy subjects, airway blood flow and FEV₁ were measured before and 30 minutes after fluticasone or placebo inhalation and 15 minutes after the subsequent inhalation of racemic albuterol (0.6 mg or 1.25 mg) or (R)-albuterol (0.3 mg or 0.6 mg).

Results

In healthy subjects all albuterol formulations increased airway blood flow equally after placebo or fluticasone pretreatment. In asthmatic subjects airway blood flow response was blunted after placebo and acutely restored after fluticasone pretreatment. Fluticasone pretreatment did not increase FEV₁ responses to any albuterol formulation, except 0.6 mg racemic albuterol.

Conclusion

A single dose of an inhaled glucocorticoid restores β₂-adrenergic airway vasodilator responses in patients with mild asthma. The mechanism of this rapid glucocorticoid effect remains to be clarified.

Key words: Asthma, airway blood flow, corticosteroids, fluticasone, nongenomic action, β₂-agonists, albuterol, levalbuterol