Article information
RESUMO
Passando-se em revista os dados cientificos acerca dos agonistas beta de actuação prolongada. afirmase que eles não cumprem o objectivo para que foram sintetizados – a utilização regular como terapêutica de manutenção.
O facto de não possuírem propriedades anti-inflamatórias é um grande handicap já que é esta a função que se pretende para uma terapêutica de fundo da asma.
Mais do que a broncodilataçã o, interessaria que fossem capazes de limitar as consequências das agressões agudas das vias aéreas. Contudo, verificase que têm o efeito de diminuir a protecção em relção a agressões inalatórias como as da metacolina, da histamina ou do alergénio e o seu uso regular agrava a broncoconstrição do exercício. Para além disso, induz tolerância ao efeito broncodilatador do Salbutamol.
Por isso, parecem limitadas as indicações para o uso deste tipo de medicamentos, que não deve em circunstância alguma ser admioistrado como monoterapia.
Se nas asmas ligeiras e moderadas encontramos facilmente outras opções eficazes, fica de pé, para além da prevenção da asma nocturna, a sua utilizaçãio nas asmas de maior gravidade, como presumível potenclador do papel dos corticosteroides.
Palavras-chave:
Betamiméticos
broncodilatação
asma
ABSTRACT
On reviewing the scientific data on the long-acting beta-agonists, it is pointed out they do not meet the goals they were synthetized – the regular use as maintenance therapy.
The fact that they do not possess anti-inflammatory properties is a great handicap because that is exactely the aim of long-term asthma therapy.
More than bronchodilation, one would be interested that long-acting beta-agonists could prevent the excessive airway narrowing under inbalatory agression. However, it has been observed that its regular administration decreases the protection against inhaled methacholine, histamine and allergen, and that it does not protect against exercise bronchooonstriction. Futhermore, they induce tolerance to Salbutamol bronchodilation.
The usefulness of this drugs seems, therefore, to be scarce. They should not, in any circunstance, be administered as monotherapy.
If for mild and moderate asthma we easily find other options, we remain, beside the nocturnal asthma prevention, with its use in more severe cases of asthma as presumable potentiator of corticosteroids.
Key-words:
betamimetics
bronchodilation
asthma
Full text is only aviable in PDF
BIBLIOGRAFIA
[1.]
A. Mugge, D. Posselt, V. Reiner, et al.
Effects of β2-adrenoceptoragonists fenoterol and salbutamol on force or contraction in isolated human ventricular miocardium.
Klin Wonchenschr, 63 (1985), pp. 26-31
[2.]
O. Coqueret, B. Dugas, J.M. Mencia-Huerta, P. Braquet.
Regulation of IgE production from human monuclear cells by β-2-adrenoceptor agonists.
Clin. Exp Allergy, 25 (1995), pp. 304-311
[3.]
I.W. Wainer.
Three dimensional view of pharmacology.
Am J. Hosp. Pharm., 49 (1992), pp. 54-58
[4.]
P.H. Howarth, Durham S.R. Leeth, et al.
Influence of albuterol, cromolyn sodium and ipratropium bromide on the airway and circulating mediator responses to allergic bronchial – provocation in asthma.
Am. Rev Respir Dis, 132 (1985), pp. 986-992
[5.]
A.S. Vathenen, A.J. Knox, B.G. Higgins, et al.
Re-bound increase in bronchial responsiveness after treatment with inhaled terbutaline.
Lancet, 1 (1988), pp. 554-558
[6.]
B.J. O’Connor, S.L. Aikman, P.J. Barnes.
Tolerance to the nonbronchodilator effects of inhaled 2-agonists in asthma N Engl.
J. Med., 327 (1992), pp. 1204-1208
[7.]
D.W. Cockcroft, C.P. Mc Parland, S.A. Britto, et al.
Regular inhaled salbutamol and airway responsiveness to allergen.
Lancet, 342 (1993), pp. 833-837
[8.]
M. Wooley, S.O. Anderson, M. Quigley.
Duration of protective effect of terbutaline sulphate and cromolyn sodium alone and in combination on exercise asthma.
Chest, 97 (1990), pp. 39-45
[9.]
L. Machado, G. St Alheim, P. Malmberg.
Early and late asthmatic reactions, phystological characterisucs.
Clin. Allergy, 16 (1986), pp. 11-17
[10.]
C.K.N. Lai, O.P. Twentyman, S.T. Holgate.
The effect of an increase in inhaled allergen dose after inhaled rimiterol hydro bromide and the concurrence and magnitude of the late asthmatic response and the associated changes 10 nonspecific bronchial responsiveness.
Am. Rev. Respir Dis., 140 (1987), pp. 917-923
[11.]
R.E. Ruffin, M.B. Dolovich, R.K. Wolff, M.T. Newhouse.
The effects of preferential deposition of histamine in the human airway.
Am Rev. Respir. Dis., 117 (1978), pp. 485-492
[12.]
B.L. Laube, D.L. Swift, H.N. Wagner.
The effect of bronchial obstruction on central airway deposition of a saline aerosol in patients with asthma.
Am Rev. Respir Dis., 133 (1986), pp. 740-743
[13.]
M. Svartengren, K. Philipson, L. Linnman, P. Camner.
Regional deposition of particles in human lung after induced bronchoconstriction.
Exp. Lung. Res., 10 (1986), pp. 223-233
[14.]
K.F. Chung, K. Jeyashing, P.D. Snashall.
Influence of airway calibre on the intrapulmonary dose and distribution of inhaled aerosol in normal and asthmatic subjects.
Eur Respir. J., 1 (1988), pp. 890-895
[15.]
E.J. Ariens.
Pharmacology of airway smooth muscle.
Bronchial hyperresponsiveness, normal and abnormal control, assessment and therapy, pp. 22
[16.]
J.A. Pinto Mendes, A.J. Segorbe Luis, A.M. Todo-Bom, et al.
Reacções asmáticas tardías. simpaticomiméticos e hiperreactividade brônquica.
Via Pneumológica, 1 (1991), pp. 57-64
[17.]
M.D. Inman, P.M. O' Byrne.
The effect of regular inhaled albuterol on exercise-induced bronohoconstriction.
Am. J. Respir. Cri Care Med., 153 (1996), pp. 65-69
[18.]
D.W. Cockcroft, P.M. O'Byrne, V.A. Swystun, et al.
Regular use of inhaled albuterol and the allergen- induced late asthmatic response.
J. Allergy Clin. Immunology, 96 (1995), pp. 44-49
[19.]
E.H. Bel, A.H. Zwinderman, M.C. Timmers, et al.
The protective effect of a beta-2 agonist aganist excessive airway narrowing an response to bronchoconstrictor stimul in asthma and chronic obstructive disease.
Thorax, 46 (1991), pp. 9-14
[20.]
A. Roquet, E. Ihre, G. Hallden, et al.
Induction of bronchial hyperreactivity by repeated low dose allergen exposure(Abstract).
Allergy, 51 (1996), pp. 89
[21.]
P. Alendouro, M.B. Tavares, J.A. Pinto Mendes, et al.
What relationship between immediate and late reactions to allergen? (Abstract).
AC-I News, (1994), pp. 403
[23.]
M.R. Sears, D.R. Taylor, C.G. Prjn, et al.
Regular inhaled β-agnist treatment In bronchial asthma.
Lancet, 336 (1990), pp. 1391-1396
[24.]
D.R. Taylor, M.R. Sears, G.P. Herbison, et al.
Regular inhaled β-agonist in asthma: effects on exacerbauon and lung function.
Thorax, 48 (1993), pp. 134-138
[25.]
C.P. Vanschayk, E. Donpeung, C.L.A. Van Herwaarden, et al.
Bronchodilator treatment in moderata asthma or chronic bronchitis: continuous or on demand? A randomized controlled study.
B.M.J., 303 (1991), pp. 1426-1431
[26.]
C.P. Van Schayk, S.G.M. Cloosterman, Hoflan-Did, et al.
How detrimental is chronic use of bronchodilators in asthma and chronic obstructive pulmonary disease?.
Am. J. Respir. Crit Care Med, 1 (1995), pp. 1317-1319
[27.]
D.R. Taylor, M.R. Sears.
Regular beta-adrenergic agonists. Evidence, not reassurance, is what is needed.
Chest, 106 (1994), pp. 552-559
[28.]
I.M. Adcock, M.J. Peters, C.R. Crown, et al.
Interactions between steroids and β2-agonists in vitro.
Bur. Respir. J, 7 (1994), pp. 421-425
[29.]
R. Dahl, B. Pedersen, P. Venge.
Bronchoalveolar lavage studies Bur Respir.
Rev., 1 (1991), pp. 272-275
[30.]
B. Johnson.
The preclinical pharmacology of salmeterol: non-bronchodilator effects.
Eur. Respir. Rev., 1 (1991), pp. 257-260
[31.]
P.R. Butchers, C.J. Vardey, M. Johnson.
Salmeterol a potent and long acting inhibator of inflammatory mediator release from human lung.
Br. J. Pharmacol., 104 (1991), pp. 672-676
[32.]
S. Sanjar, P.J. Mc Cabe, A.H. Humbles.
Inhibition by salmeterol of antigen-induced eosinophil acumulation in guienea-pig lung.
Eur Respir. J., 4 (1991), pp. 2005
[33.]
C.J. Whelan, M. Johnson.
Inhibition by salmeterol of increased vasccular permeability and granulocyte acumulation an guienea pig lung and skin.
Br J. Pharmacol., 105 (1992), pp. 831-838
[34.]
R. Dahl, B. Pedersen.
The influence of Inhaled salmeterol on bronchial inflammation, A bronchoalveolar lavage study in patients with bronchial asthma Eur.
Respir. Rev, 1 (1991), pp. 217-285
[35.]
D.P. Twentyman, J.P. Finnerty, S.T. Holgate.
The effect of inhaled salmeterol on the allergen-induced late asahmatic response (LAR) and increase in histamine responsiveness.
Eur. Respir. J., 3 (1990), pp. 225S-226S
[36.]
J.A. Roberts, P. Bradding, A.F. Walls, et al.
The effect of salmeterol xinafoate therapy on lavage findings in asthma.
Am Rev Respir. Dis., 145 (1992), pp. A418
[37.]
J.A. Roberts, P. Bradding, Walls A.F., et al.
The influence of salmeterol xinafoate on mucosal inflammation in asthma.
Am Rev. Respir. Dis., 145 (1992), pp. A418
[38.]
I.M. Adcock, M.J. Peters, C.R. Crown, et al.
Interactions between steroids and β2 -agonists in vitro.
Eur Respir. J, 7 (1994), pp. 421S
[39.]
P.V. Gardiner, C. Ward, H. Booth, et al.
Effect of eight weeks of treatment with salmeterol on bronchoalveolalar lavage inflammatory indices in asthmatics.
Am J Respir. Crit. Care Med, 150 (1994), pp. 1506-1511
[40.]
M.M.M. Pizzichini, J.C. Kidney, B.J.O. Wong, et al.
Effect of salmeterol compared with beclomethasone on allergen-induced asthmatic and inflammatory responses.
Eur Respir J, (1996), pp. 449-455
[41.]
O.P. Twentyman, S.T. Holgate.
Reversibility of the allergen provoked late asthmatic response by an inhaled 2-adreno-ceptor agonist.
Clin. Exp. Allergy, 24 (1994), pp. 245-249
[42.]
H.C. Gongora, A.F.Z. Wisniewski, A.E. Taitersfield.
A single-dose comparison of inhaled albuterol and two formulations of salmeterol on airway reactivity in asthmatic subjects.
Am. Rev Respir. Dis., 144 (1991), pp. 626-629
[43.]
K.F. Rabe, R. Jörres, D. Nowak, et al.
Comparison of the effects of salmeterol and formoterol on airway tone and responsiveness over 24 hours in bronchial asthma.
Am. Rev. Respir. Dis, 147 (1993), pp. 1436-1441
[44.]
A.A.P.H. Verberne, W.C.J. Hop, R.W.G. Creeyghton, et al.
Airway responsiveness after a single dose and during 4 months of treatment with salmeterol in asthmatic children (Abstract).
Am. J. Respir. Crit Care Med., 149 (1994), pp. A349
[45.]
J. Schanning, J. Vilsvik, A.H. Henriksen, G. Bratten.
Efficacy and duration of salmeterol powder an halation in protecting against exercise induced bronchoconstriction.
Ann Allergy Asthma Immunol, 76 (1996), pp. 57-60
[46.]
J.L. Malo, H. Ghezzo, C. Trudeau, et al.
Salmeterol, a new inhaled beta-2 adrenergic, has a longer blocking effect than albuterol on hypervenulation-induced broncho-constriction.
J. Allergy Clin Immunol, 89 (1992), pp. 567-574
[47.]
O.P. Twentyman, I.P. Finnerty, A. Harrts, et al.
Protecilon against allergen-induced asthma by salmeterol.
Lancet, 336 (1990), pp. 1338-1342
[48.]
D. Cheung, M.C. Timmers, A.H. Zwinderman, et al.
Long-term effects of a long-acung β2-adrenoceptor agonist, salmeterol, on airway responsiveness in patients with mild asthma.
N. Engl. J Med, 327 (1992), pp. 1198-1203
[49.]
R. Bhagat, S. Kalra, V.A. Swystvn, et al.
Rapid onset of tolerance to the bronchoprotective effect of salmeterol.
Chest, 105 (1995), pp. 1235-1239
[50.]
L. Ramage, R.J. Lipworth, C.G. Ingram, et al.
Reduced protection against exercise-induced bronohoconstriction after chrome dosing With salmeterol.
Respir Med, 88 (1994), pp. 363-368
[51.]
J.B.D. Palmer, K.A. Richard, J.R. Thompson.
Risks of salmeterol.
N Engl J Med, 331 (1994), pp. 1341
[52.]
L.P. Boulet.
Long-versus short-action·β2-agonists implications for drug therapy.
Drugs, 47 (1994), pp. 207-222
[53.]
A. Grove, B.J. Lipworth.
Bronchodilator subsenstivity to salbutamol after twice daily salmeterol in asthmatic patients.
Lancet, 346 (1995), pp. 201-206
[54.]
Govea, L.C. McFarlane, B.J. Lipworth.
Evaluation of theβ2 adrenoceptor agoinst/antagonist activity of formoterol and salmeterol.
Thorax, 51 (1996), pp. 54-58
[55.]
A. Linden, A. Bergendal, Ullman A., et al.
Salmeterol, fenoterol, and salbutamol in the isolated guinea pig trachea differences m maximum relaxant effect and potency but not in fuctional antagonism.
Thorax, 48 (1993), pp. 547-553
[56.]
M.E. Williams, E.V. Gervino, Rossa R.M., et al.
Catecholamine modulation of rapid potassium shifts during exercise.
N. Engl. J. Med., 312 (1985), pp. 823-827
[57.]
A. Woolcock, B. Lundback, N. Ringdal, L.A. Jac-Ques.
Comparison of addition of salmeterol to inhaled steroids with doubling of the dose of inhaled steroids.
Am J Respir Crit. Care Med., 153 (1996), pp. 1481-1488
[58.]
S. Oddera, M. Silvestrj, R. Testi, G.A. Rossi.
Salmeterol enhances in vitro the inhabitory effects of dexamethasone on allergen-induced T-lymphocyte activation, partially supressing the release of GM-CSF and TNFα (Abstract).
Eur Respir J, 17 (1994), pp. 468S
[59.]
S. Kalra, V.A. Swyston, R. Bhagat, O.W. Cockcroft.
Inhaled corticosteroids do not prevent the development of tolerance to the bronchoprotective effect of salmeterol.
Chest, 109 (1996), pp. 953-956
[60.]
R. Mann.
Drug Safety Research Unit-Southampton Results of prescription event monitoring study of salmeterol.
B.M.J., 309 (1994), pp. 1018
[61.]
D.S. Pearlman, P. Chervinsky, La Force, et al.
A comparison of salmeterol with salbutamolm the treatment of mild-to-moderate asthma.
N. Engl. J Med., 327 (1992), pp. 1420-1425
[62.]
M.G. Britton, J.S. Earnshaw, J.B.D. Palmer.
A twelve month comparison of salmeterol with salbutamol in asthmatic patients.
Eur Respir. J, 5 (1992), pp. 1062-1067
[63.]
B. Lundback, D.W. Rawlison, J.B.D. Palmer.
Twelve month comparison of salmeterol and salbutamol as dry powder formulations in asthmatic patients.
Thorax, 48 (1993), pp. 148-153
[64.]
G.E. D'Alonzo.
Efficacy of inhaled salmeterol in the treatment of asthma.
Eur Respir Rev, 5 (1995), pp. 128-132
[65.]
R. Fuller.
Safety of salmeterol in the treatment of asthma.
Eur Respir Rev, 27 (1995), pp. 133-137
[66.]
W. Castle, R. Fuller, J. Hall, J. Palmer.
Sereventnation wide surveilance study: comparison of salmeterol with salbutomol asthmatic patients who require regular bronchodilator treatment.
B.M.J., 306 (1993), pp. 1034-1037
Recommended
articles
articles
Pulmonol. 2024;30:324-6
Pulmonol. 2024;30:344-51
Pulmonol. 2023;29:486-94
Open access
This work is licensed under a Creative Commons Attribution 4.0 International License.
Publish in
Pulmonology
Pulmonology
- Home
- All contents
- Publish your article
- About the journal
- Metrics
- Open access
Article options