There is currently clinical evidence for combining long-acting anti-muscarinic agents with inhaled corticosteroids for treatment of asthma. The interaction of these two medications, however, has not been researched. This study looked at beclomethasone, an inhaled corticosteroid, and glycopyrronium, a long-acting anti-muscarinic agent on human airway smooth muscle tone. To obtain the human airway smooth muscle, portions of lungs undergoing lobectomy for lung cancer were cooled, dissected, and stored. The human airway smooth muscle was tested with beclomethasone alone and also in combination with glycopyrronium. The bronchorelaxant effect of the medications was measured on the tissues.
The results of this study showed that the administration of beclomethasone and glycopyrronium caused significant relaxation of bronchi and bronchioles when the tissue was sensitized (pre-contracted with histamine). The effect was dependent by the activation of a G-protein and subsequent kinase cascade. In non-sensitized bronchi, however, the effects of the medications were not synergistic. Therefore, it was concluded that synergistic interaction occurred with an increase of cAMP concentrations involved with the kinase cascade.
The research of this study not only provides information on the interaction of two medications, but also on the efficacy of utilizing them together to treat asthma. This study is interesting to me because the researchers decided to delve deeper into the pharmacologic reason for using the two types of medications together. By understanding how these medications work together, pharmacists and other healthcare practitioners can better dose these medications and use them to effectively treat asthma and similar conditions.
Cazzola M, Calzetta L, Rogliani P, et al. Interaction between corticosteroids and muscarinic antagonists in human airways. Pulm Pharmacol Ther. 2016;36:1-9.