Effects of salmeterol on cilia and mucus in COPD and pneumonia patients

The present study was performed to evaluate the effects of salmeterol xynaphoate on ciliary beat frequency (CBF) of nasal epithelium and on rheological parameters of tracheobronchial mucus. We studied 10 steady-state COPD patients, eight patients with community-acquired pneumonia and eight healthy subjects as controls. They underwent a nasal brushing of the inferior turbinate to study the CBF in basal conditions and following application of salmeterol at 10(-5), 10(-6), 10(-7) and 10(-8) M concentrations directly to the epithelial samples. We also collected sputum samples, in COPD patients only, by the technique for "protected expectoration" for the rheological assessment in basal conditions and following addition of salmeterol at 10(-5), 10(-6), 10(-7) and 10(-8) M concentrations. Only samples with basal viscosity values higher than 2000 mPa/s were admitted. Our results confirmed previous studies that demonstrate a ciliostimulating effect induced by salmeterol. The mean basal CBF was 11.18 +/- 0.75 Hz in control subjects, while the pathological subjects showed a markedly lower basal values: 8.64 +/- 0.88 Hz (p = 0.000) and 8.83 +/- 0.68 Hz (p = 0.000), in COPD and pneumonia patients, respectively. Salmeterol induced ciliostimulation in both patients groups as well as the healthy controls. The maximum increase in CBF, highly significant, was obtained at 10(-6) M concentrations of salmeterol, while this effect decreased at lower concentrations. Regarding the action of salmeterol on rheological parameters, a direct effect of salmeterol on mucus cannot been demonstrated and the described beneficial clinical effects on mucociliary clearance occurring in vivo are probably related to an indirect effect of stimulation of ciliary beat. This preliminary study suggests that, in addition to COPD, salmeterol could be a useful therapeutic agent in pneumonia also, for its positive effect on ciliary movement other than bronchodilation, but this finding needs further investigations.