Asthma salmeterol

Salmeterol is a long-acting inhaled bronchodilator and is not used to treat acute asthma symptoms. It does not replace the fast-acting inhalers for sudden symptoms. Salmeterol should not be used more frequently than twice daily (morning and evening). 

Although both formoterol and salmeterol are effective as add-on therapy for moderate persistent asthma, neither agent should be used as monotherapy for chronic asthma. Patients treated with salmeterol alone are at greater risk of worsening asthma than those treated with inhaled corticosteroids.25,26... 

The answer is c. (Katzung, pp 340-3422 Salmeterol is a long-acting p2-adrenergic agonist that is effective in asthma prophylaxis. Skeletal mus-... 

Nelson HS, Weiss ST, Bleecker ER, Yancey SW, Dorinsky PM. (2006) The Salmeterol Multicenter Asthma Research Trial a comparison of usual pharmacotherapy for asthma or usual pharmacotherapy plus salmeterol. Chest. 129,15-26. 

Sears MR, Taylor DR. (1993) BronchodUator treatment in asthma. Increase in deaths during salmeterol treatment unexplained. BMJ. 306, 1610-1611. 

Lanes SF, Lanza LL, Wentworth CE, III. (1998) Risk of emergency care, hospitalization, and ICU stays for acute asthma among recipients of salmeterol. Am J Respir Crit Care Med. 158, 857-861. 

Salbutamol is a selective beta2-receptor agonist indicated in the management of asthma as a bronchodilator relieving acute attacks. It may be used in combination with inhaled corticosteroids such as beclometasone. Salbutamol acts within a few minutes and tends to be short-acting, unlike salmeterol. Side-effects of salbutamol include tachycardia and palpitations. It does not cause drowsiness and does not precipitate oral candidiasis. Inhaled corticosteroids may precipitate oral candidiasis. 

Severe cases may, however, require an intensified bronchodilator treatment with systemic jk-mimetics or theophylline (systemic use only low therapeutic index monitoring of plasma levels needed). Salmeterol is a long-acting in-halative P2-mimetic (duration 12 h onset -20 min) that offers the advantage of a lower systemic exposure. It is used prophylactically at bedtime for nocturnal asthma. 

Sympathomimetics Accor6 ng to the National Asthma Education and Prevention Program s Expert Panel Report II, long-acting 2-agonists (eg, salmeterol) are used... 

Asthma/Bronchospasm - For asthma/bronchospasm in children 4 years of age and older, use 1 inhalation/disk (50 meg) twice daily (12 hours apart). Adverse effects are more likely to occur with higher doses of salmeterol, and more frequent administration or administration of a larger number of inhalations is not recommended. 

Long-term use Prolonged use of ephedrine may produce a syndrome resembling an anxiety state many patients develop nervousness a sedative may be needed. Acute symptoms Do not use salmeterol to relieve acute asthma symptoms. If the patient s short-acting, inhaled 2-agonist becomes less effective (eg, the patient... 

Data from a large, placebo-controlled US study that compared the safety of salmeterol or placebo added to usual asthma therapy showed a small but significant increase in asthma-related deaths in patients receiving salmeterol (13 deaths out of 13,174 patients treated for 28 weeks) vs those on placebo (4 of 13,179). Subgroup analyses suggest the risk may be greater in blacks compared with whites. 

Recommended Starting Doses of Fluticasone Propionate/Salmeterol for Asthma Patients (Age 12) Taking Inhaled Corticosteroids ... 

If asthma control is not optimal, conventional advice was to increase the ICS dose. However, it is now apparent, that the dose-response effect of ICS is rather flat, so that there is little improvement in lung function after doubling the dose of inhaled steroid. An alternative strategy is to add some other class of controller drug. Several studies have shown that the combination of ICS and salmeterol or formoterol was more effective than increasing the dose of inhaled corticosteroid in terms of lung function improvement, rescue /32-agonist use, symptom control, and frequency of mild and severe asthma exacerbations. 

Inhaled salmeterol has a pharmacological half-life in excess of 12 hours, much longer than either albuterol or terbutaline. The likely basis for this long half-hfe is that the long lipophilic tail of salmeterol promotes retention of the molecule in the cell membrane. Its long duration of action makes salmeterol particularly suitable for prophylactic use, such as in preventing nocturnal symptoms of asthma. Because of its relatively slow onset of action, salmeterol should not be used to treat acute symptoms. 

Terbutaline, albuterol, salmeterol and other Pj-adrenoceptor agonists are used primarily in the management of asthma. Terbutaline and albuterol have very rapid onset of action and are indicated for acute symptom rehef Salmeterol, in contrast, has a slow onset of action but a long duration of action. Salmeterol is thus used as prophylactic therapy only, not to reverse acute symptoms. 

Dr David Graham from the FDA, speaking to the US senate in 2004, controversially raised concerns (refuted by the respective Pharmaceutical Companies) over the safety of the retinoid, isotretinoin (used in the treatment of cancer), the statin, rosuvastatin (used to lower cholesterol), a long-acting p2-receptor antagonist, salmeterol (used in asthma therapy), and a selective serotonin reuptake inhibitor, paroxetine (used as an antidepressant) (21). 

Patients receiving salmeterol for asthma should normally also be receiving regular and adequate doses of an effective asthma controller medication, such as inhaled corticosteroid... 

The P2 selective adrenergic agonists are most widely used drugs for the treatment of asthma. They are effective after oral and inhaled administration and have a longer duration of action. Albuterol (salbutamol), salmeterol, bitolterol, pir-buterol are available as aerosol pack in metered dose. 

Treatment with omalizumab, the monoclonal humanized anti-IgE antibody, is reserved for patients with chronic severe asthma inadequately controlled by high-dose inhaled corticosteroid plus long-acting B-agonist combination treatment (eg, fluticasone 500 meg plus salmeterol 50 meg inhaled twice daily). This treatment reduces lymphocytic, eosinophilic bronchial inflammation and effectively reduces the frequency and severity of exacerbations. It is reserved for patients with demonstrated IgE-mediated sensitivity (by positive skin test or radioallergosorbent test [RAST] to common allergens) and an IgE level within a range that can be reduced sufficiently by twice-weekly subcutaneous injections. 

Salmeterol Selective B2 agonist Slow onset, primarily preventive action potentiates corticosteroid effects Asthma prophylaxis Aerosol inhalation duration 12-24 h Toxicity Tremor, tachycardia, overdose arrhythmias... 

Uses Chronic asthma Actions Topical steroid Dose Two inhalations dd-qid or 4 inhal bid Caution [C, ] Contra Component allergy Disp Met-dose inhaler SE Cough, oral candidiasis Interactions T Risk of GI bleed W/ ASA, NSAIDs T effects W/ salmeterol, troleandomycin T effects W/ barbiturates, hydantoins, pheny-toin, rifampin 1 effects OF diuretics, insulin, oral hypoglycemics, K supl, salicylates, somatrem, live virus vaccines EMS May affect glucose(hypeiglycemia) monitor ECG for hypokalemia (flattened T waves) concurrent ASA/NSAID use may T risk of GI bleeding OD Acute OD unlikely to cause life-threatening Sxs, chronic OD may lead to S/Sxs of muscle weakness, and osteoporosis symptomatic and supportive... 

A 23-year-old man, with a history of asthma, house dust mite allergy, and rhinoconjunctivitis, presented with acute respiratory symptoms. He was given oral cetirizine, inhaled salmeterol, and fluticasone propionate, and oral prednisone 40 mg/day for 1 week and 20 mg/day for 1 week. His asthma recurred when prednisone was withdrawn and he took oral prednisone 60 mg/day for 1 week and 40 mg/day for 1 week. He also took montelukast 10 mg/day. He then developed severe peripheral edema with a gain in weight of 13 kg. Prednisone was withdrawn and his edema resolved. Montelukast was continued. 

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