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Letters to the Editor

Indian Pediatrics 1998; 35:681-682

Salmeterol in Exercise Induced Asthma


Exercise induced asthma (EIA) is a condition in which vigorous physical activity triggers acute narrowing of airways in children with heightened airway reactivity(1). A fall in PEFR of more than 15% following a significant exercise challenge of 5-8 minutes duration is generally accepted as diagnostic of EIA(2,3).

Good physical training will increase the resting airway function and hence is beneficial to the asthmatics(2). Exercise, unlike other antigenic stimuli, does not induce long term deterioration of lung function(1). Hence exercises must be encouraged in asthmatics with proper interventions to reduce or abort EIA.

Inhaled salbutamol just before exercise is known to prevent EIA(1,2). However, some children find it rather delicate to use it in front of their peers. Such children may prefer treatment with a long acting drug like salmeterol(4) that can be used before leaving for school. There is paucity of Indian literature on the use of salmeterol for EIA in children. Hence a descriptive study was undertaken to find out whether inhaled salmeterol before leaving for school can prevent EIA during recreational exercises in school.

The study subjects consisted of 12 boys, 12-14 years of age with a mean (SD) reduction of PEFR of 24% (2.26) following a piacebo inhalation and a defined exercise protocol administered 8 hours later. The defined exercise protocol consisted of constant speed running for 5 minutes followed by sprinting to exhaustion, the required pace being maintained by a trained athlete running along side these subjects. This protocol was selected because their physical training in the school included a similar schedule which regularly provoked EIA. The study subjects were already familiar with the technique of using metered dose inhalers and mini peak flow meters.

The study was conducted in a play ground with temperature and relative humidity of 29
± 2°C and 65 ± 5%, respectively which is the expected normal for this place. Salmeterol (50 µg) was administered using metered dose inhaler and the baseline PEFR was recorded 8 hours later. Then the defined exercise protocol was administered and PEFRs were recorded at 5, 10, and 15 minutes after the exercise. The test was repeated after one week. The lowest of the PEFRs recorded for each child was compared with the pre-exercise PEFR of that particular child.

When salmeterol was administered, the mean (SD) reduction in PEFR after exercise was only 9.25% (1.96) compared to a mean reduction of 24% (2.26) after placebo. This difference was found to be significant (p < 0.001). Thus the study shows that under favorable conditions of temperature and humidity, 50
µg salmeterol provides significant protection against EIA when challenged 8 hours later.


A. Santhosh kumar,
Assistant Professor,
Department of Pediatrics,
Medical College (SAT) Hospital,
Thiruvananthapuram
695 011,
India.
 

References

1. McFadden ER, Gilbert IA. Exercise induced asthma. N Engl J Med 1994; 330: 1362-1367.

2. Pierson WE. Exercise induced bronchospasm in children and adolescents. Pediatr Clin North Am 1988; 35: 1031-1040.

3. Godfrey 5, Bar-Yishay E. Exercise induced asthma, In: Bronchial Asthma, 2nd edn. Eds. Weiss EB, Segal MS, Stein M. Toronto, Little Brown and Co, 1985; pp 500-507.

4. Green CP, Price JF. Prevention of exercise induced asthma by inhaled salmeterol. Arch Dis Child 1992; 67: 1014-1017.
 

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