In the same regimen, which component provides anti-inflammatory action?

• A. Salmeterol
• B. Montelukast
• C. Theophylline
• D. Fluticasone

Answer: (D)

Anti-inflammatory action in this regimen comes from an inhaled corticosteroid. Fluticasone works by binding glucocorticoid receptors in airway cells and suppressing the transcription of numerous inflammatory genes, which lowers the production of cytokines and chemokines, reduces the recruitment and activation of eosinophils and other inflammatory cells, and decreases edema and mucus production. This broad and potent anti-inflammatory effect is what helps control chronic airway inflammation long-term.

The other components mainly provide bronchodilation or mild anti-inflammatory effects: a long-acting beta-agonist relaxes airway smooth muscle; montelukast blocks leukotriene receptors with some anti-inflammatory impact but not as strong; theophylline offers bronchodilation with a lesser, more indirect anti-inflammatory effect and carries more systemic considerations.