Loss of bronchoprotection to Salbutamol during sputum induction with hypertonic saline: implications for asthma therapy

Hongyu WangMelanie KjarsgaardTerence HoJohn D. Brannan and Parameswaran Nair

Abstract

Background

Sputum induction with hypertonic saline in obstructive airway diseases is generally safe. However, saline induces bronchoconstriction in some patients despite pre-medication with Salbutamol. Our objectives were to investigate the predictors of failure of Salbutamol to protect against saline-induced-bronchoconstriction in patients with asthma and COPD and to evaluate implications for asthma therapy.

Methods

Retrospective survey on a database of 3565 patients with obstructive airway diseases who had sputum induced with hypertonic saline. The effect of baseline FEV1, bronchitis and concomitant medication on saline-induced-bronchoconstriction (≥ 15% drop in FEV1) were examined by logistic regression analysis. A subgroup had this re-examined 8–12 weeks after decreasing long-acting-beta-2-agonist dose or after adding Montelukast, which included an assessment of mast cell activity in sputum.

Results

222 (6.2%) patients had saline-induced-bronchoconstriction despite pre-treatment with inhaled Salbutamol. Baseline airflow obstruction (FEV1% predicted < 60% OR 3.29, p < 0.001) and long-acting-beta-agonist use (OR 2.02, p = 0.001), but not bronchitis, were predictors of saline-induced-bronchoconstriction, which decreased when long-acting-beta-agonist dose was decreased. Refractoriness to subsequent bronchodilation was associated with mast cell activity and was attenuated by Montelukast.

Conclusion

Sputum induction with saline provides information on bronchitis and additional physiological data on tolerance to beta-agonists and mast cell activity that may have implications for clinical therapy.

Download PDF

(You must be logged in to add and reply comments)

Interasma on Twitter

Interasma RT @worldallergy: WISC 2018 - Florence Dec. 6-9 Registration online will be closed on November 20th. After this date, registration will on…
17hreplyretweetfavorite
Interasma RT @worldallergy: Top 10 Scientific Articles in the field of psychosocial aspects of allergy published in 2017 (or 2016 as noted). https://…
17hreplyretweetfavorite
Interasma RT @Aller_MD: “#Asthma biologic prices ‘far out of alignment’ with benefit, says ICER” https://t.co/rIKq8LypH9 https://t.co/t8vGuROsUw
17hreplyretweetfavorite
Interasma RT @Aller_MD: “Risk Factors ID'd for Persistent Atopic Dermatitis in Kids Could help clinicians personalize disease prediction” https://t.c…
17hreplyretweetfavorite
Interasma RT @RhinologyO: “The otolaryngologists’ non-surgical training needs to extend beyond the limits of ENT” http…
18hreplyretweetfavorite

Editor: Juan C. Ivancevich, MD

Copyright © Interasma 2003-2017  •  Terms of Use  •  Privacy Policy  •  Contact Us  •  Sitemap

Powered by FREI SA

InterAsma