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Salmeterol Improves Pulmonary Function in Persons with Tetraplegia

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Abstract

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.

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References

  1. American Thoracic Society (1995) Standardization of spirometry: 1994 update. Am Rev Respir Dis 152:1107–1136

    Google Scholar 

  2. Ashba J, Garshick E, Tun CG, et al. (1993) Spirometry: acceptability and reproducibility in spinal cord injured subjects. J Am Paraplegia Soc 16:197–203

    PubMed  CAS  Google Scholar 

  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 13:445–448

    Article  PubMed  CAS  Google Scholar 

  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 27:1471–1476

    PubMed  CAS  Google Scholar 

  5. Crapo RO, Morris AH, Clayton PD, et al. (1982) Lung volumes in healthy nonsmoking adults. Bull Eur Physiopathol Respir 18:419–425

    PubMed  CAS  Google Scholar 

  6. DeVivo MJ, Black KJ, Stover SL (1993) Causes of death during the first 12 years after spinal cord injury. Arch Phys Med Rehabil 74:248–254

    PubMed  CAS  Google Scholar 

  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 139:1218–1222

    PubMed  CAS  Google Scholar 

  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 150:1081–1085

    PubMed  CAS  Google Scholar 

  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 35:49–55

    PubMed  CAS  Google Scholar 

  10. Gounden P (1997) Static respiratory pressures in patients with post-traumatic tetraplegia. Spinal Cord 35:43–47

    Article  PubMed  CAS  Google Scholar 

  11. Grimm DR, Arias E, Lesser M, et al. (1999) Airway hyperresponsiveness to ultrasonically nebulized distilled water in subjects with tetraplegia. J Appl Physiol 86:1165–1169

    PubMed  CAS  Google Scholar 

  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 118:1397–1404

    Article  PubMed  CAS  Google Scholar 

  13. Johnson M, Butchers PR, Coleman RA, et al. (1993) The pharmacology of salmeterol. Life Sci 52:2131–2143

    Article  PubMed  CAS  Google Scholar 

  14. Jones PW, Bosh TK (1997) Quality of life changes in COPD patients treated with salmeterol. Am J Respir Crit Care Med 155:1283–1289

    PubMed  CAS  Google Scholar 

  15. Kissel JT, McDermott MP, Natarajan R, et al. (1998) Pilot trial of albuterol in facioscapulohumeral muscular dystrophy. Neurology 50:1402–1406

    PubMed  CAS  Google Scholar 

  16. Lemons VR, Wagner FC (1994) Respiratory complications after cervical spinal cord injury. Spine 19:2315–2320

    PubMed  CAS  Google Scholar 

  17. Martineau L, Horan MA, Rothwell NJ, Little RA (1992) Salbutamol, a β2-adrenoceptor agonist, increases skeletal muscle strength in young men. Clin Sci 83:615–621

    PubMed  CAS  Google Scholar 

  18. Meyer JM, Wenzel CL, Kradjan WA (1993) Salmeterol: A novel, long-acting beta2-agonist. Ann Pharmacother 27:1478–1487

    PubMed  CAS  Google Scholar 

  19. Morris JF, Koski A, Johnson LC (1971) Spirometric standards for healthy nonsmoking adults. Am Rev Respir Dis 103:57–67

    PubMed  CAS  Google Scholar 

  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 80:1264–1267

    Article  PubMed  CAS  Google Scholar 

  21. Ramirez-Venegas A, Ward J, Lentine T, Mahler DA (1997) Salmeterol reduces dyspnea and improves lung function in patients with COPD. Chest 112:336–340

    PubMed  CAS  Google Scholar 

  22. Reines HD, Harris RC (1987) Pulmonary complications of acute spinal cord injuries. Neurosurgery 21:193–196

    PubMed  CAS  Google Scholar 

  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 41:59–64

    PubMed  Google Scholar 

  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 127:149–155

    Article  PubMed  Google Scholar 

  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 76:55–58

    Article  PubMed  CAS  Google Scholar 

  26. Singas E, Lesser M, Spungen AM, et al. (1996) Airway hyperresponsiveness to methacholine in subjects with spinal cord injury. Chest 110:911–915

    PubMed  CAS  Google Scholar 

  27. Spungen AM, Dicpinigaitis PV, Almenoff PL, Bauman WA (1993) Pulmonary obstruction in individuals with cervical spinal cord lesions unmasked by bronchodilator administration. Paraplegia 31:404–407

    PubMed  CAS  Google Scholar 

  28. Spungen AM, Grimm DR, Lesser M, et al. (1997) Self-reported prevalence of pulmonary symptoms in subjects with spinal cord injury. Spinal Cord 35:652–657

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Center for the Medical Consequences of Spinal Cord Injury, James J. Peters Veterans Affairs Medical Center, Room 1E-02, 130 West Kingsbridge Road, Bronx, New York, 10468, USA

    Gregory J. Schilero

  2. Basic Sciences Department, New York Chiropractic College, Seneca Falls, New York, 13148, USA

    David R. Grimm

  3. Department of Medicine, Mount Sinai School of Medicine, New York, New York, 10029, USA

    Gregory J. Schilero, Ann M. Spungen & William A. Bauman

  4. Department of Rehabilitation Medicine, Mount Sinai School of Medicine, New York, New York, 10029, USA

    Ann M. Spungen & William A. Bauman

  5. Medical Service, James J. Peters Veterans Affairs Medical Center, Bronx, New York, 10468, USA

    Gregory J. Schilero, Ann M. Spungen & William A. Bauman

  6. Spinal Cord Injury Service, James J. Peters Veterans Affairs Medical Center, Bronx, New York, 10468, USA

    Ann M. Spungen & William A. Bauman

  7. Center for the Medical Consequences of Spinal Cord Injury, James J. Peters Veterans Affairs Medical Center, Bronx, New York, 10468, USA

    Gregory J. Schilero, Ann M. Spungen, William A. Bauman & Marvin Lesser

Authors
  1. David R. Grimm
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  2. Gregory J. Schilero
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  3. Ann M. Spungen
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  4. William A. Bauman
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  5. Marvin Lesser
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Correspondence to Gregory J. Schilero.

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Grimm, D.R., Schilero, G.J., Spungen, A.M. et al. Salmeterol Improves Pulmonary Function in Persons with Tetraplegia. Lung 184, 335–339 (2006). https://doi.org/10.1007/s00408-006-0011-6

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  • DOI: https://doi.org/10.1007/s00408-006-0011-6

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