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Acute lung injury
In vitro and in vivo effects of salbutamol on neutrophil function in acute lung injury
  1. G D Perkins1,
  2. N Nathani2,
  3. D F McAuley3,
  4. F Gao1,
  5. D R Thickett2
  1. 1Intensive Care Unit, Birmingham Heartlands Hospital, Birmingham, UK
  2. 2Lung Investigation Unit, Queen Elizabeth Hospital, University of Birmingham, Birmingham, UK
  3. 3Department of Intensive Care Medicine, Queen’s University of Belfast, Belfast, UK
  1. Correspondence to:
    G D Perkins
    Lung Investigation Unit, Nuffield House, Queen Elizabeth Hospital, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK; gavin.perkins{at}virgin.net

Abstract

Background: Intravenous salbutamol (albuterol) reduces lung water in patients with the acute respiratory distress syndrome (ARDS). Experimental data show that it also reduces pulmonary neutrophil accumulation or activation and inflammation in ARDS.

Aim: To investigate the effects of salbutamol on neutrophil function.

Methods: The in vitro effects of salbutamol on neutrophil function were determined. Blood and bronchoalveolar lavage (BAL) fluid were collected from 35 patients with acute lung injury (ALI)/ARDS, 14 patients at risk from ARDS and 7 ventilated controls at baseline and after 4 days’ treatment with placebo or salbutamol (ALI/ARDS group). Alveolar–capillary permeability was measured in vivo by thermodilution (PiCCO). Neutrophil activation, adhesion molecule expression and inflammatory cytokines were measured.

Results: In vitro, physiological concentrations of salbutamol had no effect on neutrophil chemotaxis, viability or apoptosis. Patients with ALI/ARDS showed increased neutrophil activation and adhesion molecule expression compared with at risk-patients and ventilated controls. There were associations between alveolar–capillary permeability and BAL myeloperoxidase (r = 0.4, p = 0.038) and BAL interleukin 8 (r = 0.38, p = 0.033). In patients with ALI/ARDS, salbutamol increased numbers of circulating neutrophils but had no effect on alveolar neutrophils.

Conclusion: At the onset of ALI/ARDS, there is increased neutrophil recruitment and activation. Physiological concentrations of salbutamol did not alter neutrophil chemotaxis, viability or apoptosis in vitro. In vivo, salbutamol increased circulating neutrophils, but had no effect on alveolar neutrophils or on neutrophil activation. These data suggest that the beneficial effects of salbutamol in reducing lung water are unrelated to modulation of neutrophil-dependent inflammatory pathways.

  • ALI, acute lung injury
  • ARDS, acute respiratory distress syndrome
  • BAL, bronchoalveolar lavage
  • FMLP, N-formyl-l-leucin-methionyl-l-phenylalanine
  • LPS, lipopolysaccharide
  • TNF, tumour necrosis factor

https://doi.org/10.1136/thx.2006.059410

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    Footnotes

    • Published Online First 23 August 2006

    • Funding: This study was supported by a grant from the West Midlands Intensive Care Society, Queen Elizabeth Hospital, Birmingham, UK.

    • Competing interests: GDP, DFMcA and DRT have received payment to attend scientific meetings and have given talks for pharmaceutical companies that manufacture β- agonists (Astra Zeneca, GlaxoSmithKline).

    • Ethical approval: This study was approved by the East Birmingham Research Ethics Committee (Reference SJR/LMH/0522).