Addition of salmeterol or theophyylline to an inhaled corticosteroid regimen in patients with severe asthma

Abstract

Objectives: The aim of this study was to compare the efficacy of addition of salmeterol or theophylline to an inhaled steroids regimen in the treatment of severe asthma. Design: A crossover study. Material and Methods: Fifteen patients (5 male, 10 female) aged 18 to 51 years were included in this crossover study. All patients were suffering from severe asthma and were on inhaled steroids (800-1000 mg/daily, fluticasone propionate). They were also taking inhaled short acting $\beta$2-agonists as required. The patients were randomised; 8 patients received inhaled salmeterol (50 $\mu$g twice daily) and 7 received once-daily sustained release theophylline (400-600 mg/daily) for four weeks. At the end of this four-week period, the treatments were stopped for a week (wash-out period) and following this period, the treatments were interchanged. Outcome measurements (improved mean baseline FEV1, increase in PEFR from baseline, mean morning and evening PEFR, decreased rescue medication, symptom-free days and nights) were compared in the two treatment groups at the end of the study. Results: A greater but not significant increase in forced expiratory volume (FEV1) was observed in the salmeterol group. Rescue medication was not required on 82.7% of the days during the treatment period in salmeterol patients and on 75.5% of the days in theophylline patients. The frequency of symptom-free nights was significantly higher in the theophylline group. Conclusions: Salmeterol was found to be superior to theophylline in improving FEV1 while theophylline was more effective than salmeterol in controlling nocturnal symptoms in asthma patients taking inhaled steroids.