, Volume 184, Issue 6, pp 335–339 | Cite as

Salmeterol Improves Pulmonary Function in Persons with Tetraplegia

  • David R. Grimm
  • Gregory J. Schilero
  • Ann M. Spungen
  • William A. Bauman
  • Marvin Lesser


β2-Adrenergic agonists are known to improve muscle strength because of anabolic properties. The purpose of this study was to determine if long-term administration of a long-acting β2-adrenergic agonist to subjects with tetraplegia is associated with improvement in pulmonary function parameters and maximal static inspiratory and expiratory mouth pressures (MIP and MEP, respectively), measures of respiratory muscle strength. The study was a randomized, prospective, double-blind, placebo-controlled, crossover trial and conducted at the James J. Peters Veterans Affairs Medical Center. Thirteen subjects who had complete or incomplete tetraplegia for more than one year participated in the study. Eleven subjects completed the study. All were clinically stable outpatients without any history of asthma or use of inhaled bronchodilators. Following baseline measurements, patients were randomized to receive salmeterol or placebo from identically marked Diskus containers for 4 weeks. Following a 4-week washout period, the subjects were randomized to receive the alternate preparation for 4 weeks. Pulmonary function parameters and static mouth pressure were measured during baseline and during the fourth week of the two study periods. During the 4-week period of salmeterol administration, forced vital capacity, forced expiratory volume in 1 s, peak expiratory flow, MIP, and MEP improved significantly compared with placebo and baseline. Expiratory reserve volume increased significantly compared to baseline. Increases in MIP and MEP during salmeterol administration suggest improvement in respiratory muscle strength. However, this cannot be stated with certainty because MIP and MEP are dependent on volume parameters at which they are measured. Regardless of the mechanism, improvement in static mouth pressures indicates that salmeterol should benefit these individuals by improving cough effectiveness.


Spinal cord injury Spirometry Bronchodilator Respiratory muscle strength Salmeterol Tetraplegia 


  1. 1.
    American Thoracic Society (1995) Standardization of spirometry: 1994 update. Am Rev Respir Dis 152:1107–1136Google Scholar
  2. 2.
    Ashba J, Garshick E, Tun CG, et al. (1993) Spirometry: acceptability and reproducibility in spinal cord injured subjects. J Am Paraplegia Soc 16:197–203PubMedGoogle Scholar
  3. 3.
    Bennett JA, Harrison TW, Tattersfield AE (1999) The contribution of the swallowed fraction of an inhaled dose of salmeterol to its systemic effects. Eur Respir J 13:445–448PubMedCrossRefGoogle Scholar
  4. 4.
    Caruso JF, Signorile JF, Perry AC, et al. (1995) The effects of albuterol and isokinetic exercise on the quadriceps muscle group. Med Sci Sports Exerc 27:1471–1476PubMedGoogle Scholar
  5. 5.
    Crapo RO, Morris AH, Clayton PD, et al. (1982) Lung volumes in healthy nonsmoking adults. Bull Eur Physiopathol Respir 18:419–425PubMedGoogle Scholar
  6. 6.
    DeVivo MJ, Black KJ, Stover SL (1993) Causes of death during the first 12 years after spinal cord injury. Arch Phys Med Rehabil 74:248–254PubMedGoogle Scholar
  7. 7.
    Estenne M, Knoop C, Vanvaerenbergh J, Heilporn A, De Troyer A (1989) The effect of pectoralis muscle training in tetraplegic patients. Am Rev Respir Dis 139:1218–1222PubMedGoogle Scholar
  8. 8.
    Estenne M, Van Muylem A, Gorini M, et al. (1994) Evidence of dynamic airway compression during cough in tetraplegic patients. Am J Respir Crit Care Med 150:1081–1085PubMedGoogle Scholar
  9. 9.
    Fein ED, Grimm DR, Lesser M, et al. (1998) The effects of ipratropium bromide on histamine-induced bronchoconstriction in subjects with cervical spinal cord injury. J Asthma 35:49–55PubMedGoogle Scholar
  10. 10.
    Gounden P (1997) Static respiratory pressures in patients with post-traumatic tetraplegia. Spinal Cord 35:43–47PubMedCrossRefGoogle Scholar
  11. 11.
    Grimm DR, Arias E, Lesser M, et al. (1999) Airway hyperresponsiveness to ultrasonically nebulized distilled water in subjects with tetraplegia. J Appl Physiol 86:1165–1169PubMedGoogle Scholar
  12. 12.
    Grimm DR, Chandy D, Almenoff PL, Schilero G, Lesser M (2000) Airway hyperreactivity in subjects with tetraplegia is associated with reduced baseline airway caliber. Chest 118:1397–1404PubMedCrossRefGoogle Scholar
  13. 13.
    Johnson M, Butchers PR, Coleman RA, et al. (1993) The pharmacology of salmeterol. Life Sci 52:2131–2143PubMedCrossRefGoogle Scholar
  14. 14.
    Jones PW, Bosh TK (1997) Quality of life changes in COPD patients treated with salmeterol. Am J Respir Crit Care Med 155:1283–1289PubMedGoogle Scholar
  15. 15.
    Kissel JT, McDermott MP, Natarajan R, et al. (1998) Pilot trial of albuterol in facioscapulohumeral muscular dystrophy. Neurology 50:1402–1406PubMedGoogle Scholar
  16. 16.
    Lemons VR, Wagner FC (1994) Respiratory complications after cervical spinal cord injury. Spine 19:2315–2320PubMedGoogle Scholar
  17. 17.
    Martineau L, Horan MA, Rothwell NJ, Little RA (1992) Salbutamol, a β2-adrenoceptor agonist, increases skeletal muscle strength in young men. Clin Sci 83:615–621PubMedGoogle Scholar
  18. 18.
    Meyer JM, Wenzel CL, Kradjan WA (1993) Salmeterol: A novel, long-acting beta2-agonist. Ann Pharmacother 27:1478–1487PubMedGoogle Scholar
  19. 19.
    Morris JF, Koski A, Johnson LC (1971) Spirometric standards for healthy nonsmoking adults. Am Rev Respir Dis 103:57–67PubMedGoogle Scholar
  20. 20.
    Murphy RJL, Hartkopp A, Gardiner PF, Kjaer M, Beliveau L (1999) Salbutamol effect in spinal cord injured individuals undergoing functional electrical stimulation training. Arch Phys Med Rehabil 80:1264–1267PubMedCrossRefGoogle Scholar
  21. 21.
    Ramirez-Venegas A, Ward J, Lentine T, Mahler DA (1997) Salmeterol reduces dyspnea and improves lung function in patients with COPD. Chest 112:336–340PubMedGoogle Scholar
  22. 22.
    Reines HD, Harris RC (1987) Pulmonary complications of acute spinal cord injuries. Neurosurgery 21:193–196PubMedGoogle Scholar
  23. 23.
    Schilero GJ, Grimm D, Spungen A, Lenner R, Lesser M (2004) Bronchodilator responses to metaproterenol sulfate among subjects with spinal cord injury. J Rehabil Res Dev 41:59–64PubMedGoogle Scholar
  24. 24.
    Schilero GJ, Grimm DR, Bauman WA, Lenner R, Lesser M (2005) Assessment of airway caliber and bronchodilator responsiveness in subjects with spinal cord injury. Chest 127:149–155PubMedCrossRefGoogle Scholar
  25. 25.
    Signorile JF, Banovac K, Gomez M, et al. (1995) Increased muscle strength in paralyzed patients with spinal cord injury: Effect of a beta-2 adrenergic agonist. Arch Phys Med Rehabil 76:55–58PubMedCrossRefGoogle Scholar
  26. 26.
    Singas E, Lesser M, Spungen AM, et al. (1996) Airway hyperresponsiveness to methacholine in subjects with spinal cord injury. Chest 110:911–915PubMedGoogle Scholar
  27. 27.
    Spungen AM, Dicpinigaitis PV, Almenoff PL, Bauman WA (1993) Pulmonary obstruction in individuals with cervical spinal cord lesions unmasked by bronchodilator administration. Paraplegia 31:404–407PubMedGoogle Scholar
  28. 28.
    Spungen AM, Grimm DR, Lesser M, et al. (1997) Self-reported prevalence of pulmonary symptoms in subjects with spinal cord injury. Spinal Cord 35:652–657PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, Inc. 2006

Authors and Affiliations

  • David R. Grimm
    • 2
  • Gregory J. Schilero
    • 1
    • 3
    • 5
    • 7
  • Ann M. Spungen
    • 3
    • 4
    • 5
    • 6
    • 7
  • William A. Bauman
    • 3
    • 4
    • 5
    • 6
    • 7
  • Marvin Lesser
    • 7
  1. 1.Center for the Medical Consequences of Spinal Cord InjuryJames J. Peters Veterans Affairs Medical CenterBronxUSA
  2. 2.Basic Sciences DepartmentNew York Chiropractic CollegeSeneca FallsUSA
  3. 3.Department of MedicineMount Sinai School of MedicineNew YorkUSA
  4. 4.Department of Rehabilitation MedicineMount Sinai School of MedicineNew YorkUSA
  5. 5.Medical ServiceJames J. Peters Veterans Affairs Medical CenterBronxUSA
  6. 6.Spinal Cord Injury ServiceJames J. Peters Veterans Affairs Medical CenterBronxUSA
  7. 7.Center for the Medical Consequences of Spinal Cord InjuryJames J. Peters Veterans Affairs Medical CenterBronxUSA

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