Combined Effects of Salmeterol and FP in COPD

Salmeterol + FP

Airway

Obstruction

Inflammation

StructuralChanges

Smooth muscle contraction

Increased cholinergic tone

Loss of elastic recoil

Increased Neutrophils,macrophages,

CD8+ lymphocytes.

Elevated IL-8, TNFa?

Protease/anti-proteaseimbalance

Alveolar destruction

Collagen deposition

Glandular hypertrophy

Airway fibrosis

? Symptoms

? FEV1

? Exacerbations