By David Douglas
NEW YORK (Reuters Health) – Use of salmeterol alone or in combination with beclomethasone is associated with oral mucosal injury in pediatric asthma patients, according to Mexican researchers.
Dr. Arturo Berber of the Hospital Infantil de Mexico "Federico Gomez", Nueva Santa Maria, and colleagues note that use of short-acting beta2-agonist may negatively affect oral health. This, they suggest, is "probably provoked by decreased saliva flow and decreased concentrations of immunoglobulin (Ig)A in saliva."
To investigate the effect of a long-acting beta-agonist alone or with concomitant use of an inhaled steroid, the researchers conducted a single-blind crossover study of 28 children (ages 6 to 15 years) with moderate asthma. At baseline they underwent an oral cavity examination. Also assessed were levels of saliva flow and IgA and total protein in saliva. Results were normal in all patients.
The children were then randomized to two 6-week treatment periods with a daily dose of salmeterol 100 mcg alone or in combination with beclomethasone 400 mcg via metered-dose inhaler. The oral and saliva assessments were repeated after each treatment period.
As reported in the November issue of the Annals of Allergy, Asthma, and Immunology, 13 patients showed symptoms of gingivitis following salmeterol alone. After combination therapy, 10 had gingivitis and 1 had lower lip ulceration. None had candidiasis or severe mucosal injury.
No statistically significant difference over baseline was seen in saliva flow after either treatment. However, total and protein-adjusted saliva IgA level was significantly higher after salmeterol than at baseline or after combination therapy.
In light of the similar incidence of mucosal injury in both groups, the researchers postulate that "saliva flow is not the only protective factor for gingivitis."
Furthermore, in a comment to Reuters Health, Dr Berber added that although "the use of inhaled salmeterol alone or in combination with beclomethasone induces injuries in oral mucosa such as gingivitis…the mechanism behind this damage is not related to the IgA content of saliva."
Ann Allergy Asthma Immunol 2001;87:420-423.
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