Addition of Salmeterol or Theophylline to an Inhaled Corticosteroid Regimen in Patients With Severe Asthma

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 P2-agonists as required. The patients were randomised; 8 patients received inhaled salmeterol (50 tig 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 FEVj, 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 (FEVj) 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 FEVj while theophylline was more effec­tive than salmeterol in controlling nocturnal symptoms in asthma patients taking inhaled steroids.