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Bronchoprotective effect of vilanterol against methacholine-induced bronchoconstriction in mild asthmatics: A randomized three-way crossover study.
Ann Allergy Asthma Immunol. 2018 09; 121(3):328-332.AA

Abstract

BACKGROUND

Ultra-long-acting β2 agonists (uLABA) are relatively new anti-asthma medications of which there are three different formulations currently available: olodaterol, indacaterol, and vilanterol. The first 2 formulations have been shown to exert bronchoprotective effects; they are able to prevent airway smooth muscle contraction on exposure to constricting stimuli. However, studies have found that these 2 drugs produce different degrees and durations of bronchoprotection against methacholine.

OBJECTIVE

The objective of this study was to investigate the degree of bronchoprotection provided by vilanterol against methacholine-induced bronchoconstriction.

METHODS

Fourteen patients with mild-to-moderate asthma (8 male; baseline percent predicted forced expiratory volume in 1 second [FEV1] > 65%; provocative concentration of methacholine causing a 20% reduction in FEV1 [PC20] ≤ 8 mg/mL) completed this randomized, double-blind, 3-way crossover study. Methacholine challenges were performed before treatment administration (placebo, 100 μg fluticasone furoate, or 25 μg vilanterol + 100 μg fluticasone furoate) and at 0.5 and 24 hours posttreatment. Each treatment arm was separated by a minimum 7-day washout period. A combination therapy of vilanterol+fluticasone furoate was used, because vilanterol is not available as a monotherapy.

RESULTS

Significant bronchoprotection was evident after the combination treatment at both 0.5 and 24 hours with doubling dose shifts in methacholine PC20 of 2.0 (P = .0004) and 1.6 (P = .0001), respectively. Clinically significant bronchodilation was only recorded at 24 hours after combination treatment (P < .05).

CONCLUSION

These findings suggest that vilanterol (in combination with fluticasone furoate) provides significant bronchoprotection against methacholine-induced bronchoconstriction for at least 24 hours in patients with mild-to-moderate asthma.

CLINICAL TRIAL REGISTRATION

clinicaltrials.gov (NCT03315000).

Authors+Show Affiliations

Department of Physiology, Division of Respirology, Critical Care and Sleep Medicine, College of Medicine, University of Saskatchewan, Saskatoon, Canada.Department of Medicine, University of Saskatchewan, Saskatoon, Canada.Department of Medicine, University of Saskatchewan, Saskatoon, Canada.Department of Physiology, Division of Respirology, Critical Care and Sleep Medicine, College of Medicine, University of Saskatchewan, Saskatoon, Canada; Department of Medicine, University of Saskatchewan, Saskatoon, Canada. Electronic address: don.cockcroft@usask.ca.

Pub Type(s)

Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

30017826

Citation

Westbury, Grace L M., et al. "Bronchoprotective Effect of Vilanterol Against Methacholine-induced Bronchoconstriction in Mild Asthmatics: a Randomized Three-way Crossover Study." Annals of Allergy, Asthma & Immunology : Official Publication of the American College of Allergy, Asthma, & Immunology, vol. 121, no. 3, 2018, pp. 328-332.
Westbury GLM, Blais CM, Davis BE, et al. Bronchoprotective effect of vilanterol against methacholine-induced bronchoconstriction in mild asthmatics: A randomized three-way crossover study. Ann Allergy Asthma Immunol. 2018;121(3):328-332.
Westbury, G. L. M., Blais, C. M., Davis, B. E., & Cockcroft, D. W. (2018). Bronchoprotective effect of vilanterol against methacholine-induced bronchoconstriction in mild asthmatics: A randomized three-way crossover study. Annals of Allergy, Asthma & Immunology : Official Publication of the American College of Allergy, Asthma, & Immunology, 121(3), 328-332. https://doi.org/10.1016/j.anai.2018.07.005
Westbury GLM, et al. Bronchoprotective Effect of Vilanterol Against Methacholine-induced Bronchoconstriction in Mild Asthmatics: a Randomized Three-way Crossover Study. Ann Allergy Asthma Immunol. 2018;121(3):328-332. PubMed PMID: 30017826.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Bronchoprotective effect of vilanterol against methacholine-induced bronchoconstriction in mild asthmatics: A randomized three-way crossover study. AU - Westbury,Grace L M, AU - Blais,Christianne M, AU - Davis,Beth E, AU - Cockcroft,Donald W, Y1 - 2018/07/12/ PY - 2018/01/06/received PY - 2018/03/07/revised PY - 2018/04/07/accepted PY - 2018/7/19/pubmed PY - 2019/4/11/medline PY - 2018/7/19/entrez SP - 328 EP - 332 JF - Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology JO - Ann. Allergy Asthma Immunol. VL - 121 IS - 3 N2 - BACKGROUND: Ultra-long-acting β2 agonists (uLABA) are relatively new anti-asthma medications of which there are three different formulations currently available: olodaterol, indacaterol, and vilanterol. The first 2 formulations have been shown to exert bronchoprotective effects; they are able to prevent airway smooth muscle contraction on exposure to constricting stimuli. However, studies have found that these 2 drugs produce different degrees and durations of bronchoprotection against methacholine. OBJECTIVE: The objective of this study was to investigate the degree of bronchoprotection provided by vilanterol against methacholine-induced bronchoconstriction. METHODS: Fourteen patients with mild-to-moderate asthma (8 male; baseline percent predicted forced expiratory volume in 1 second [FEV1] > 65%; provocative concentration of methacholine causing a 20% reduction in FEV1 [PC20] ≤ 8 mg/mL) completed this randomized, double-blind, 3-way crossover study. Methacholine challenges were performed before treatment administration (placebo, 100 μg fluticasone furoate, or 25 μg vilanterol + 100 μg fluticasone furoate) and at 0.5 and 24 hours posttreatment. Each treatment arm was separated by a minimum 7-day washout period. A combination therapy of vilanterol+fluticasone furoate was used, because vilanterol is not available as a monotherapy. RESULTS: Significant bronchoprotection was evident after the combination treatment at both 0.5 and 24 hours with doubling dose shifts in methacholine PC20 of 2.0 (P = .0004) and 1.6 (P = .0001), respectively. Clinically significant bronchodilation was only recorded at 24 hours after combination treatment (P < .05). CONCLUSION: These findings suggest that vilanterol (in combination with fluticasone furoate) provides significant bronchoprotection against methacholine-induced bronchoconstriction for at least 24 hours in patients with mild-to-moderate asthma. CLINICAL TRIAL REGISTRATION: clinicaltrials.gov (NCT03315000). SN - 1534-4436 UR - https://www.unboundmedicine.com/medline/citation/30017826/Bronchoprotective_effect_of_vilanterol_against_methacholine_induced_bronchoconstriction_in_mild_asthmatics:_A_randomized_three_way_crossover_study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1081-1206(18)30566-0 DB - PRIME DP - Unbound Medicine ER -