Efficacy is a contributing factor to the clinical onset of bronchodilation of inhaled beta(2)-adrenoceptor agonists.

Inhaled beta(2) adrenoceptor (beta(2) AR) agonists are widely used as bronchodilator therapies for asthma and COPD. Different agonists have varying rates of onset of action, e.g. indacaterol and salbutamol are effective bronchodilators within 5 min whereas salmeterol takes 15 min to achieve significant bronchodilation over baseline (Brookman et al., Curr Med Res Opin 23:3113-3122, 2007). This has been attributed to differences in the lipophilicity of the agonists such that hydrophobic ligands take longer to diffuse into tissue and may even access the receptor via the membrane compartment (Anderson et al., Eur Respir J 7:569-578, 1994). While this holds true for salmeterol and salbutamol, the relatively high lipophilicity of indacaterol should result in a slower onset of action. Here we have explored the possibility that the efficacy of these ligands may also contribute to their onset of action. We have characterised efficacy and rate of cyclic adenosine monophosphate (cAMP) accumulation in primary human bronchial smooth muscle cells using a competition assay (AlphaScreen, Perkin Elmer) and in HEK 293-GloSensor cells endogenously expressing the beta(2) AR using a luminescence readout. For all agonists tested, cAMP was generated in a concentration-dependent manner. For both assay formats, the relative efficacies were unchanged, with isoprenaline > formoterol > indacaterol > salbutamol > salmeterol. The rate of cAMP generation varied for each agonist and correlated well with intrinsic efficacy in that the high-efficacy agonists promoted the most rapid rise in cAMP levels. We have demonstrated that the rate of cAMP accumulation is influenced by agonist efficacy and that this, in combination with lipophilicity, may explain why beta(2) AR agonists demonstrate differences in their onset of action.