ICPP: Salmeterol Better than Sodium Cromoglycate at Preventing Exercise-Induced Asthma in Children

By Adrian Burton
Special to DG News

NICE, FRANCE — February 20, 2002 — Salmeterol (SLM), used as prophylactic and acute treatment of exercise-induced asthma in children, better controls the fall of FEV1 (forced expiratory volume in one second) after exercise than does sodium cromoglycate (SCG).

Theodor Zimmermann and colleagues of the Department of Pediatrics at the University of Erlangen-Nurnberg in Germany performed an open randomized cross-over design study of the two drugs. This involved 25 children (17 boys and eight girls) with a mean age of 11.9 ±2.2 years who had mild to moderate asthma (FEV1 = 2.13±0.45 L; 36 percent on inhaled glucocorticoids). The results were presented here yesterday at the Fifth International Congress on Pediatric Pulmonology.

The children were challenged with incremental treadmill exercise tests and their FEV1 was measured at baseline and after one week of treatment on either 2 x 50 µg/d SLM or 4 x 2 mg/d SCG. Patients then crossed to the other treatment after a washout period of seven days.

Data was eventually available for 22 patients. Salmeterol treatment improved spontaneous (before exercise) FEV1 (baseline 2.14 ±0.47 L; seven days 2.55 ±0.62 L), whereas SCG did not (baseline 2.17 ±0.47; seven days 2.16 ±0.47).

After initial exercise, the baseline FEV1 for the salmeterol group fell 0.30 ±0.16 L, but after seven days treatment it fell by only 0.11 ±0.15 L. In contrast, in the SCG group, baseline fall in FEV1 at initial exercise was 0.27 ±0.21 L, and was still falling by 0.22 ±0.15 L after seven days of treatment.

Maximal fall in FEV1 after exercise was also measured. In the SLM group this was 0.39 ±0.16 L at baseline but only 0.15 ±0.13 after seven days of treatment. Although SLG worked, it was less effective. At baseline, maximal FEV1 fall after exercise was 0.4 ±0.24 L, and after seven days treatment was only improved to a loss of 0.27 ±0.16 L. "Both drugs worked, but the better one was salmeterol," remarked Dr. Zimmermann.

The calculated protective efficacy of the drugs was clearly in favor of salmeterol (Hodges-Lehmann test: +54.84 percent; Wilcoxon p= 0.0056).

"If we want to protect these children from exercise-induced asthma, salmeterol seems like the better drug," concluded Dr. Zimmermann.

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