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Copyright ©ERS Journals Ltd 2003
Comparative bronchial vasoconstrictive efficacy of inhaled glucocorticosteroids
1 Pulmonary and Critical Care Division, Dept of Medicine, University of Miami at Mount Sinai and 2 Dept of Epidemiology and Public Health, University of Miami, Miami, FL, USA
CORRESPONDENCE: A. Wanner, Division of Pulmonary and Critical Care Medicine, University of Miami School of Medicine, P.O. Box 016960 (R-47), Miami, FL 33101, USA. Fax: 1 3052436992. E-mail: awanner@miami.edu
Keywords: asthma, bronchial blood flow, corticosteroid, vasoconstriction
Received: August 8, 2002
Accepted February 10, 2003
This research was supported by an academic research grant from Glaxo Inc., Middlesex, UK.
The vasoconstrictive efficacies of glucocorticosteroids (GS) are usually compared by the McKenzie skin-blanching test and taken as an index of relative potency. The rationale for the present study was to transpose the McKenzie test to the airway and to compare the airway vascular effects of three inhaled GS: beclomethasone dipropionate (BDP), fluticasone propionate (FP) and budesonide (BUD), in healthy subjects and patients with mild stable asthma.
A soluble, inert gas-uptake method was used to measure airway blood flow (Qaw). Baseline mean±sd Qaw normalised for anatomical dead space was 53.1±1.4 µL·min–1·mL–1 in healthy subjects (n=10) and 67.8±3 µL·min–1·mL–1 in asthmatics (n=10).
All GS caused a transient decrease in Qaw. The magnitude of the vasoconstriction was greater in asthmatics. The relative vasoconstrictive effect of BDP, FP and BUD was 1, 1.9, and 2.7, respectively, in asthmatics and 1, 3.3 and 3.0, respectively, in healthy subjects, as assessed by the dose required to decrease Qaw by 20% from the baseline, 30-min postdrug inhalation.
Therefore, measuring airway blood flow may be a useful, site-specific parameter to assess the tissue bioavailability and vasoconstrictive efficacy of inhaled glucocorticosteroids.
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