(9R)-9-chloro-11-17-dihydroxy-17-(2-hydroxy-1-oxoethyl)-10-13-16-trimethyl-6-7-8-11-12-14-15-16-octahydrocyclopenta[a]phenanthren-3-one and Cough

Cough in isolation of other clinical features is known as non-specific cough, which has been defined as non-productive cough in the absence of identifiable respiratory disease or any known aetiology. In children with non-specific cough the possibility of asthma being the underlying disorder is often raised (so called cough variant asthma). The proponents of cough variant asthma suggest a therapeutic trial of medications usually used to treat asthma.. To determine the efficacy of inhaled corticosteroids in non-specific cough in children over the age of two years.. Searches were conducted on Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE. Searches were current as of March 2004.. All randomised (randomised and quasi-randomised) controlled clinical trials in which an inhaled corticosteroid (beclomethasone (BDP), fluticasone (FP), triamcinalone (TAA) or any other corticosteroid) were given for cough in children over two years of age were included. Two review authors independently assessed articles for inclusion and methodological quality.. Data from trials was extracted by both review authors and entered into the Cochrane Collaboration software program RevMan Analyses 1.0.2.. Two trials met the inclusion criteria (123 participants). One compared inhaled beclomethasone dipropionate (400 micrograms per day) with placebo and the other compared fluticasone propionate (2 mg per day for 3 days followed by 1 mg per day for 11 days) with placebo. Both studies used metered dose inhalers via a spacer. With the lower dose of inhaled corticosteroid there was no significant difference between the beclomethasone and placebo groups. With the higher dose there was a significant improvement in nocturnal cough frequency after two weeks in children presenting with persistent nocturnal cough. However, a significant but smaller improvement was also seen with placebo.. In one study beclomethasone dipropionate (400 micrograms per day) was no different from placebo in reducing the frequency of cough measured objectively or scored subjectively. There might be a small improvement with very high-dose inhaled corticosteroid but the clinical impact of this is unlikely to beneficial.

Topics: Adrenal Cortex Hormones; Androstadienes; Anti-Asthmatic Agents; Asthma; Beclomethasone; Child; Child, Preschool; Cough; Fluticasone; Humans; Randomized Controlled Trials as Topic

Over an 18-month period 31 patients (27 female and 4 male) were referred to the ENT department of our clinic for a 1-month to 14-year history of isolated non-productive cough. As ENT examination, including posterior rhinoscopy, was normal, these patients were sent to the pneumology department. Physical examination and X-ray films of the chest were negative, and the patients did not take an angiotensin converting enzyme inhibitor that could have induced this cough. Inhalation of acetylcholine lowered vital capacity by 32 +/- 14% and forced expiratory volume by 34 +/- 16%, a test which is the hallmark of bronchial hyperreactivity. Three patients were atopic. We believe that this cough can be the only manifestation of bronchial asthma. In these patients, cough was suppressed or strongly attenuated by the inhalation, 5 times a day, of salbutamol 200 mg puffs and beclomethasone dipropionate 250 mcg. In addition, the atopic patients were prescribed 10 puffs of sodium cromoglycate per day. Complaints of isolated non-productive cough must always suggest that possibility of bronchial asthma, and a bronchial provocation test must be performed to confirm this diagnosis.

Topics: Adolescent; Adult; Aged; Albuterol; Asthma; Beclomethasone; Bronchial Provocation Tests; Chronic Disease; Cough; Cromolyn Sodium; Female; Humans; Hypersensitivity, Immediate; Male; Middle Aged

Topics: Administration, Inhalation; Asthma; Beclomethasone; Bronchiectasis; Cough; Double-Blind Method; Formoterol Fumarate; Humans

Little is known of the long-term symptom profile in uncontrolled asthma and whether symptoms can predict distinct phenotypes. The primary objective of these analyses was to assess diurnal profile of cough and wheeze in an uncontrolled asthma population. Secondary outcomes were to examine how these symptom profiles influence response to treatment.Twice-daily electronically recorded data from 1701 patients were examined in relation to the population demographics. Reliever treatment with salbutamol was then compared with extra-fine beclometasone/formoterol maintenance and reliever therapy (MART). Exacerbation frequency was then correlated with the symptom profile.Symptoms were commoner in older patients with an increased body mass index. In most patients, reported cough and wheeze were closely correlated (r=0.73). Two phenotypes of cough- and wheeze-predominant patients were identified; the former were overweight, older females and the latter older males. Diurnal symptoms of cough and wheeze were similarly attenuated by both therapies. MART reduced exacerbation frequency by a third compared with salbutamol, and this effect was greatest in patients with fewest reported symptoms.While cough and wheeze are highly correlated in uncontrolled asthma, some patients predominantly have cough whereas others wheeze. Symptoms and exacerbation frequency appear poorly associated, suggesting an alternative pathophysiology. MART may be the preferred option in those with fewest symptoms.

Topics: Adrenergic beta-2 Receptor Agonists; Adult; Age Distribution; Aged; Albuterol; Anti-Asthmatic Agents; Asthma; Beclomethasone; Cough; Disease Progression; Female; Formoterol Fumarate; Humans; Incidence; Male; Middle Aged; Phenotype; Regression Analysis; Respiratory Sounds; Severity of Illness Index; United Kingdom

To compare the effects of inhaled corticosteroids (ICS) and oral leukotriene modifier (LTM) montelukast on the prognosis of children with cough variant asthma (CVA), and to identify the related risk factors for the development of classic asthma in children with CVA.. Eighty-four children with CVA (2 - 6 yrs) were randomized to receive inhaled beclomethasone dipropionate 200 microg/d through pressurized metered-dose inhaler (MDI) plus spacer with mask or oral montelukast 5 mg, once at bedtime for 6 months, then followed by 18 months observation period after the end of the study medication.. There was no significant difference in antitussive days between the two groups (ICS group: 14 +/- 9 days, LTM group: 13 +/- 9 days, Z = 1.12, P = 0.25). Wheezing developed in 7.1% of the children in ICS group during 24 months follow-up period, which was significantly lower than that in LTM group (33.3%, chi2 = 8.92, P = 0.003). The prevalence of eczema or allergic rhinitis was higher in children who developed wheezing than those who did not develop wheezing (eczema: 47.1% vs. 19.4%, chi(2) = 4.16, P = 0.042; allergic rhinitis: 58.8% vs. 31.3%, chi2 = 4.40, P = 0.036). Logistic regression analysis confirmed that eczema and allergic rhinitis were risk factors for wheezing development in children with CVA, the odds ratio was 7.668 and 3.855 respectively (P < 0.05 for all). But administration of ICS was negatively correlated with the development of wheezing by an odds ratio of 0.128 (P = 0.008).. Children with CVA may progress to classic asthma; eczema and allergic rhinitis are two risk factors for wheezing development in children with CVA. Both ICS and LTM are effective antitussive treatment, but ICS may be more effective than LTM on preventing the progression of CVA to classic asthma.

Topics: Acetates; Anti-Asthmatic Agents; Asthma; Beclomethasone; Child; Child, Preschool; Cough; Cyclopropanes; Female; Follow-Up Studies; Humans; Male; Quinolines; Risk Factors; Sulfides; Treatment Outcome

It is important to determine whether chronic cough is associated with asthma and can be helped by treatment with inhaled corticosteroids.. To compare the effects of beclomethasone and placebo in patients with chronic cough for at least 8 weeks after excluding those with cough due to postnasal drip and gastroesophageal reflux disease.. A prospective, randomized, double-blind, placebo-controlled study comprising 64 patients was performed for 2 weeks. The active group received metered-dose inhaler chlorofluorocarbon-beclomethasone (1,500 microg/d), and the placebo group received identical-appearing placebo inhalers. All the participants completed a respiratory questionnaire and underwent bronchoprovocation testing (BPT) with methacholine and allergy skin testing. The primary outcome measure was a decrease in daily cough scores (symptom diary and visual analog scale) during the 2-week treatment period.. The active group comprised 44 patients and the placebo group 20 patients. Cough duration averaged 20 weeks. At the end of treatment 82% of the active group and 15% of the placebo group had complete resolution of cough. In the active group 22 patients (50%) had positive BPT results, and in the placebo group 10 patients (50%) had positive results. There was no correlation between treatment response and responses on the respiratory questionnaire, allergy skin testing, or BPT.. Therapy with high-dose inhaled beclomethasone provided an excellent response in a subgroup of patients with chronic cough that did not correlate with atopy or airway hyperresponsiveness.

Topics: Adult; Aged; Allergens; Anti-Inflammatory Agents; Beclomethasone; Bronchial Provocation Tests; Chronic Disease; Cough; Double-Blind Method; Female; Humans; Male; Methacholine Chloride; Middle Aged; Patient Compliance; Prospective Studies; Skin Tests; Spirometry; Treatment Outcome

Post-infectious persistent cough may be caused by an underlying inflammation in the airways. Due to its antiinflammatory properties, inhaled corticosteroids (ICS) may be a rational therapeutic approach to reduce cough symptoms. In this randomized, double-blind study, the efficacy of treatment with inhaled extra-fine HFA beclomethasone diproprionate (HFA-BDP) was compared with placebo in patients with post-infectious persistent cough. A total of 72 patients with persistent cough lasting at least 3 days (max. 14 days) following an acute respiratory tract infection were randomized to treatment with extra-fine HFA-BDP (400 microg twice daily for 7 days followed by 200 microg twice daily for 4 days) or placebo. The efficacy was measured by tussometry. The primary endpoint was defined as a reduction of frequency of cough epochs/h at the end of treatment (Day 11) in relation to the baseline level and in comparison to placebo, calculated as the area under the curve (AUC). The treatment with extra-fine HFA-BDP resulted in a greater reduction of cough frequency in patients with post-infectious persistent cough in comparison to placebo. The AUC from Day 1 to Day 11 for the frequency of cough epochs/h between 7:00 am and 11:00 pm was calculated as 605.8 for HFA-BDP and 847.9 for placebo, respectively (P<0.05). There is evidence that extra-fine HFA-BDP leads to a more rapid reduction of cough frequency at the beginning of treatment. A short-term treatment with extra-fine HFA-BDP could be an effective and well tolerated therapeutic option in the treatment of post-infectious persistent cough.

Topics: Acute Disease; Administration, Inhalation; Adrenal Cortex Hormones; Adult; Aerosol Propellants; Antitussive Agents; Beclomethasone; Chemistry, Pharmaceutical; Cough; Double-Blind Method; Drug Administration Schedule; Female; Germany; Humans; Hydrocarbons, Fluorinated; Male; Middle Aged; Patient Compliance; Powders; Respiratory Tract Infections; Treatment Outcome

Fentanyl, a synthetic opioid, is a popular choice amongst anesthesiologists in the operating room. Preinduction iv fentanyl bolus is associated with coughing in 28-45% of patients. Coughing due to fentanyl is not always benign and at times may be explosive requiring immediate intervention. We have studied the role of aerosol inhalation of salbutamol, beclomethasone and sodium chromoglycate in preventing fentanyl induced coughing and have compared their efficacy.. Two hundred patients aged 18-60 yr, undergoing elective laparoscopic cholecystectomy were randomized into four groups of 50 each. Group I served as control, while Groups II, III and IV received an aerosol inhalation of salbutamol, beclomethasone or sodium chromoglycate 15 min prior to entering the operating room. Following iv fentanyl (2 micro g x kg(-1)) the incidence of cough was recorded and graded as mild (1-2), moderate (3-5) and severe (> 5) depending on the number of coughs observed. Results were analyzed using 'z' and Fischer's Exact test. A P value of < or = 0.05 was considered significant.. The incidence of cough was 28% in the control group, 6%, 0% and 4% in the salbutamol, beclomethasone and sodium chromoglycate groups respectively. Occurrence of cough was significantly low (P < or = 0.05) in the treatment groups, however the difference amongst the groups was not significant (P >/= 0.05).. The use of salbutamol, beclomethasone or sodium chromoglycate aerosol 15 min prior to iv fentanyl administration minimizes fentanyl-induced coughing.

Topics: Adolescent; Adult; Albuterol; Beclomethasone; Cough; Cromolyn Sodium; Female; Fentanyl; Histamine Release; Humans; Male; Middle Aged; Preanesthetic Medication; Prospective Studies

In asthmatic subjects cough can be related to the degree of airway inflammation. The aim of this study was to evaluate the effect of treatment with high dose inhaled beclomethasone dipropionate (BDP) on cough threshold in asthmatic subjects. Cough threshold to inhaled capsaicin (one breath of 10(-8)-10(-4)M solution) and to citric acid (one breath of 10(-4)-1 M), expressed as provocative concentration of two (PC2) and four coughs (PC4), was measured in 16 normal and 36 asthmatic subjects. After baseline evaluation, asthmatic subjects were randomized in two groups: (a) Group A, n=20: treated with salbutamol (200 microg t.i.d.) plus BDP (500 microg t.i.d.); (b) Group B, n=16: treated with salbutamol plus placebo in the same doses. After 1 month, cough threshold and clinical and functional evaluation were repeated. After treatment, asthmatics of group A showed a significant improvement in PC4 citric acid, in total symptom and cough scores, and in PD20FEV1 methacholine. In asthmatics of group B, treatment caused no improvement in symptoms, PD20FEV1 methacoline and cough threshold. In addition, cough threshold was not different between normal and asthmatic subjects and, in asthmatics, cough threshold did not correlate with PD20FEV1 methacholine. These data confirm that cough in asthma can be partially related to airway inflammation.

Topics: Administration, Inhalation; Adult; Anti-Asthmatic Agents; Asthma; Beclomethasone; Capsaicin; Citric Acid; Cough; Female; Humans; Male; Treatment Outcome

To test the hypothesis that inhaled salbutamol or beclomethasone will reduce the frequency of cough in children with recurrent cough. A secondary aim was to determine if the presence of airway hyperresponsiveness (AHR) can predict the response.. Randomised, double blind, placebo controlled trial.. During a coughing phase, 43 children (age 6-17 years) with recurrent cough were randomised to receive inhaled salbutamol or placebo (phase I) for 5-7 days and then beclomethasone or placebo (phase II) for 4-5 weeks, and in a subgroup of children for 8-9 weeks. The children used an ambulatory cough meter, kept cough diaries, and performed the capsaicin cough sensitivity, hypertonic saline bronchoprovocation, and skin prick tests.. Salbutamol or beclomethasone had no effect on cough frequency or score, irrespective of the presence of AHR.. Most children with recurrent cough without other evidence of airway obstruction, do not have asthma and neither inhaled salbutamol nor beclomethasone is beneficial.

Topics: Administration, Inhalation; Adolescent; Adrenergic beta-Agonists; Albuterol; Beclomethasone; Bronchial Hyperreactivity; Child; Cough; Double-Blind Method; Drug Therapy, Combination; Female; Glucocorticoids; Humans; Lung; Male; Placebos; Recurrence; Spirometry; Treatment Failure

Herein we assess the safety of an inhaled formulation of beclomethasone dipropionate (BDP) which uses the propellant hydrofluoroalkane-134a (HFA) for the treatment of asthma. Acute local tolerability (as assessed by the incidence of cough and mean forced expiratory volume after 1 s inhalation) was similar for both BDP and placebo formulated in either chlorofluorocarbon (CFC) or HFA propellants. A total of 43 patients were treated with HFA-BDP (0, 200, 400 or 800 micrograms day-1) or CFC-BDP (800 micrograms day-1) for 14 days and their 24 h urinary free cortisol (UFC) excretion and response to cosyntropin stimulation were measured. There was no difference in UFC between any of the doses of HFA-BDP and CFC-BDP. Adrenal responsiveness to cosyntropin stimulation was normal in all but one patient. Two large 12 week phase III trials compared HFA-placebo, HFA-BDP 400 micrograms day-1 and CFC-BDP 800 micrograms day-1 (n = 347), and HFA-BDP 800 micrograms day-1 and CFC-BDP 1500 micrograms day-1 (n = 233). For HFA-BDP at either dose, CFC-BDP 800 micrograms day-1 and HFA-placebo, the number of patients with morning plasma cortisol concentrations below normal was less than 4.4% but was 14.6% for CFC-BDP 1500 micrograms day-1. The incidence of adverse events was lower in the HFA-BDP groups than in the CFC-BDP groups (P = 0.012). The data indicate that, at doses of up to 800 micrograms day-1, HFA-BDP is at least as well tolerated as CFC-BDP. Other studies have found that equivalent efficacy is reached at lower doses of HFA-BDP than CFC-BDP. Equivalent efficacy at a lower dose and equivalent safety at the same dose imply that HFA-BDP may have a more favourable risk: benefit ratio than CFC-BDP when used at the recommended lower doses.

Topics: Administration, Inhalation; Adolescent; Adult; Aerosol Propellants; Aged; Anti-Inflammatory Agents; Asthma; Beclomethasone; Chlorofluorocarbons; Cosyntropin; Cough; Cross-Over Studies; Drug Administration Schedule; Humans; Hydrocarbons, Fluorinated; Hydrocortisone; Hypothalamo-Hypophyseal System; Middle Aged; Pituitary-Adrenal System

Occupational asthma (OA) is a useful model for the study of asthma in humans. The possibility that inhaled corticosteroids, in addition to withdrawal from the workplace, could improve clinical and functional recovery from OA can be hypothesized. We assessed clinical, functional, and behavioral characteristics of 32 subjects (22 male, 10 female), in all but one of whom OA was confirmed by specific inhalation challenges induced by either high- (n=13) or low-molecular-weight (n=19) agents within 3 mo after cessation of exposure. In this randomized, crossover, double-blind study, subjects (paired for baseline PC20 and duration of symptoms after exposure) received either placebo or 1,000 micrograms of inhaled beclomethasone daily for 1 yr, followed by the alternate medication for 6 mo. Various clinical, functional, and behavioral parameters were examined at each 3-mo visit. Significant improvement in clinical (nocturnal symptoms, cough), functional (morning and evening peak expiratory flow rates), and behavioral (quality of life) parameters were detected in the active-treatment period, although the magnitude of the improvement was relatively small. Side effects (oropharyngeal, reduced cortisol) were similar in the placebo and treatment groups. Distinguishing subjects who started with the active preparation from those who were given placebo first showed that most clinical and behavioral parameters improved in the former instance, whereas there was no significant difference in the latter. We conclude that inhaled corticosteroids induce a small but significant overall improvement of the asthmatic condition in subjects with occupational asthma caused by high- and low-molecular-weight agents after withdrawal from exposure. The beneficial effect is, however, more pronounced if inhaled steroids are given early after diagnosis.

Topics: Administration, Inhalation; Adult; Allergens; Anti-Asthmatic Agents; Asthma; Beclomethasone; Bronchial Hyperreactivity; Bronchial Provocation Tests; Candida albicans; Cough; Cross-Over Studies; Double-Blind Method; Female; Forced Expiratory Volume; Glucocorticoids; Humans; Hydrocortisone; Male; Middle Aged; Molecular Weight; Occupational Diseases; Occupational Exposure; Oropharynx; Peak Expiratory Flow Rate; Quality of Life; Vital Capacity

The physiopathology of chronic cough remains obscure. We evaluated the possibility that chronic cough in nonasthmatic subjects is associated with airway inflammation, and if this is so, what the relationship between this inflammation and the possible etiology of cough might be, as well as its response to inhaled steroids. Nineteen nonsmoking, nonasthmatic subjects referred for a persistent cough (mean: 3.8 yr) were evaluated and compared with 10 normal subjects. The evaluation included a respiratory questionnaire, a physical examination, allergy skin-prick tests, chest and sinus radiographs, esophageal pH monitoring, measurements of expiratory flows, methacholine and citric acid challenges, and flexible bronchoscopy for bronchoalveolar lavage (BAL) and bronchial biopsies. Fourteen subjects further accepted participation in a randomized, double-blind crossover trial of inhaled beclomethasone (500 micrograms four times daily) and a placebo for 1 mo each. Four groups of subjects were identified according to the presence of postnasal discharge (n = 4), gastroesophageal reflux (n = 6), both conditions (n = 5), or neither (n = 4). Subjects with chronic cough had an increased number of inflammatory cells in their bronchoalveolar lavage fluid (BALF), but there was no significant difference between the four subgroups of coughers. As compared with control subjects, the bronchial biopsies of subjects with chronic cough showed increased epithelial desquamation (p = 0.004) and inflammatory cells (p = 0.005), particularly mononuclear cells (p < 0.01), in addition to submucosal fibrosis, squamous-cell metaplasia, and loss of cilia. These findings were not significantly different between the different etiologic groups. In subjects with chronic cough, basement-membrane thickness was normal and not different from that of control subjects.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Asthma; Beclomethasone; Bronchi; Bronchitis; Bronchoalveolar Lavage Fluid; Chronic Disease; Cough; Double-Blind Method; Female; Humans; Male

The effects of a dose of beclomethasone inhaler (50 micrograms) or lidocaine 10% spray on postoperative sore throat were studied in 120 patients undergoing tracheal intubation for elective surgical procedures. Fifty-four patients (90%) in the beclomethasone group scored no postoperative sore throat compared with 27 (45%) in the lidocaine group (P < 0.001). Beclomethasone inhaler seems to be highly effective in the prevention of postoperative sore throat and is therefore to be recommended before tracheal intubation for general anaesthesia.

Topics: Adult; Aerosols; Aged; Analgesics; Anesthesia, General; Beclomethasone; Cough; Female; Humans; Incidence; Intubation, Intratracheal; Lidocaine; Male; Middle Aged; Nebulizers and Vaporizers; Pharyngitis; Time Factors

Thirty-one patients with a dry cough for at least 1 h duration in more than half of the last 30 days and with no recent respiratory infection participated in a clinical trial to evaluate the effect of inhaled beclomethasone dipropionate (BDP). Lung function was normal and reversibility was excluded by spirometry before and after bronchodilator and by no diurnal variation in home peak flow monitoring. Only one had significant eosinophilia and only three were mildly hyperreactive by bronchial provocation with histamine. After a 1-week run-in period the patients were randomly allocated to receive either BDP 4 puffs of 50 micrograms b.i.d., or placebo. After 2 weeks the patients were crossed over and received the alternative treatment for another 2-week period. The degree of cough, disturbance of night sleep and peak expiratory flow morning and evening were recorded daily in a diary. Spirometry was performed at each control visit. A significant period effect from run-in to period 1 and/or from period 1 to period 2 was demonstrated for cough and disturbance at night but not for peak flow or spirometry. However, no significant treatment effect was found for any of the measured variables.

Topics: Administration, Inhalation; Adolescent; Adult; Beclomethasone; Bronchial Provocation Tests; Chronic Disease; Clinical Trials as Topic; Cough; Double-Blind Method; Female; Humans; Male; Middle Aged; Random Allocation

To test the hypothesis that patients with asthma who develop cough and wheezing after the use of beclomethasone aerosol would have a better tolerance for triamcinolone aerosol.. Randomized, double-blinded, crossover trial.. Pulmonary function laboratory.. Volunteer sample of 24 patients attending an asthma clinic who had developed cough, with or without wheezing, after inhaling beclomethasone aerosol. All patients completed the study.. Aerosols were used in habitual manufacturers' preparations and canisters, but both were administered in three puffs through the delivery system used for triamcinolone. The preparations differed in drug (beclomethasone dipropionate or triamcinolone acetonide), propellant (trichloromonofluoromethane and dichlorodifluoromethane, or dichlorodifluoromethane alone, respectively) and dispersant (oleic acid or dehydrated alcohol, respectively). PATIENTS inhaled three puffs of one aerosol on one day and three of the other on the next.. Forced expiratory volume in one second (FEV1) was measured before and after each aerosol application. The FEV1 decreased a mean of 17.7% from baseline after inhalation of beclomethasone, and 0.8% after triamcinolone (difference, 16.9; 95% confidence limits, 12.36 to 21.34; p less than 0.001). Coughs were counted after each puff. The mean number of coughs after beclomethasone aerosol inhalation was 35.8, and after triamcinolone, 0.5 (difference, 35.3; 95% confidence limits, 22.62 to 47.98, p less than 0.001).. Asthmatic patients who are unable to inhale beclomethasone aerosol due to cough or wheezing can inhale triamcinolone aerosol without difficulty. Our investigation does not determine the exact cause of the coughing and wheezing with the beclomethasone aerosol, but we suspect the dispersant as the source.

Topics: Adult; Aerosol Propellants; Aerosols; Aged; Asthma; Beclomethasone; Cough; Double-Blind Method; Female; Forced Expiratory Volume; Humans; Male; Middle Aged; Respiratory Sounds; Triamcinolone Acetonide

The clinical potency of budesonide, a new glucocorticosteroid, was compared in a randomized double-blind study with beclomethasone dipropionate in the treatment of seasonal allergic rhinitis during the ragweed-pollen season. Sixty-one subjects were matched according to their skin sensitivity to ragweed-pollen extract and the severity of ragweed-induced rhinitis during the previous season. Thirty subjects received budesonide, and 31 received beclomethasone dipropionate, 50 micrograms per actuation. A double-dummy technique was used to achieve blinding, since the aerosol canisters and adaptors were dissimilar. Subjects were instructed to keep rhinitis well controlled by starting intranasal trial medication as soon as symptoms became troublesome, two puffs into each nostril, when it was needed, up to four times per day. If this became inadequate, subjects received supplementary chlorpheniramine maleate, 4 mg. Nasal symptoms (none = 0, mild = 1, moderate = 2, and severe = 3) and all medication use were recorded daily in a diary. Budesonide demonstrated better clinical potency than beclomethasone in that less was needed to maintain good control of nasal symptoms. Side effects were mild and transient for both groups.

Topics: Administration, Inhalation; Beclomethasone; Budesonide; Conjunctivitis; Cough; Female; Humans; Male; Middle Aged; Pregnenediones; Rhinitis, Allergic, Seasonal

Cough and wheezing are frequent side effects of inhaling beclomethasone dipropionate aerosol (BA) in patients with asthma. Twenty percent of our outpatient asthmatic subjects are unable to take BA due to these side effects. Twelve patients with history of severe cough and wheezing after inhaling BA were tested. Three puffs of either BA or placebo (Plc) were administered from a metered dose inhaler (MDI) in a double-blind crossover design. They coughed a mean of 31 times after BA and 19 times after Plc. Forced expiratory volume in one sec (FEV1) declined a mean of 22.6 percent after BA and 22.0 percent after Plc. Pretreatment with albuterol attenuated both the cough and the drop in FEV1. Follow-up study showed that regular pretreatment with bronchodilator enabled seven of 12 patients to tolerate BA therapy. The remaining five required a short course of increased dose oral steroid therapy. Cough and wheezing are frequent side effects of BA therapy that interfere with regular compliance. Pretreatment with a bronchodilator is effective in attenuating these side effects in some patients; in others, a short course of oral steroid therapy may be necessary.

Topics: Aerosols; Albuterol; Asthma; Beclomethasone; Cough; Double-Blind Method; Forced Expiratory Volume; Humans; Respiratory Sounds

We studied 17 asthmatic patients complaining of coughing attacks, with or without asthma, when inhaling beclomethasone dipropionate aerosol (Becotide). Specific airway resistance (SRaw) was measured immediately after a maximal inspiration (MI) and after Becotide inhalation. The effect of a second inhalation of Becotide was measured 10 min after inhalation of salbutamol. MI and Becotide induced large, but transient, SRaw increases in all patients; in addition, the latter induced coughing reactions. After salbutamol pretreatment, Becotide inhalation did not increase SRaw but coughing usually persisted. In 6 patients only, the increase in SRaw after Becotide was larger than that observed after MI. In those patients, placebo and Aldecine (similar to Becotide except for the metering valve) aerosols induced SRaw increases similar to that observed after Becotide. These data suggest that Becotide-induced bronchoconstriction is mainly related to the deep breath required for the inhalation. Non-specific irritation of the airways was probably responsible for the additional bronchoconstriction noticed in some patients.

Topics: Aerosols; Airway Resistance; Albuterol; Asthma; Beclomethasone; Bronchial Spasm; Cough; Humans; Premedication

Topics: Adrenal Cortex Hormones; Aerosols; Asthma; Beclomethasone; Bronchitis; Chronic Disease; Clinical Trials as Topic; Cough; Humans; Spasm

Beclomethasone dipropionate aerosol therapy can replace or diminish systemic corticosteroid therapy in the majority of asthmatics. In a clinical trial of 41 patients with perennial asthma, the 10 who had not required long-term corticosteroid therapy improved symptomatically and in pulmonary function. Of the 31 who had required prolonged systemic corticosteroid therapy 12 were able to discontinue oral prednisone therapy, 15 were able to decrease the maintenance dose of prednisone and only 4 were unable to decrease the dose; all maintained satisfactory lung function and some showed improvement. Discontinuation of systemic corticosteroid therapy was accomplished more readily in patients whose daily maintenance dose was less than 15 mg and who had been taking the drug for less than 3 years. Side effects consisted of a "dry throat" in seven patients, two of whom had throat infections with Candida albicans. Recurrence of rhinitis after discontinuation or reduction of systemic corticosteroid therapy was noted in 11 patients.

Topics: Administration, Oral; Adolescent; Adult; Aerosols; Aged; Asthma; Beclomethasone; Bronchodilator Agents; Child; Chronic Disease; Clinical Trials as Topic; Cough; Female; Humans; Hydrocortisone; Male; Methylprednisolone; Middle Aged; Prednisone; Respiratory Function Tests; Sputum

Topics: Administration, Intranasal; Adult; Aerosols; Aged; Asthma; Beclomethasone; Bronchitis; Chronic Disease; Clinical Trials as Topic; Cough; Female; Humans; Male; Methylprednisolone; Middle Aged; Rhinitis; Rhinitis, Allergic, Seasonal

The aims of the present study were to examine the prevalence and clinical features of cough variant asthma (CVA) among patients with chronic and persistent cough at an outpatient clinic in Japan, and the efficacy of treatment with an inhaled corticosteroid.. This prospective study was conducted at a general internal medicine outpatient clinic in Japan over a 12-month period. CVA was diagnosed as chronic cough without wheezing or any apparent cause, that had persisted for more than 8 weeks, with a normal CXR and spirometry but with bronchial hyperresponsiveness to methacholine, and relief of cough after bronchodilator treatment. We also examined the effects of inhaled beclomethasone propionate on symptoms and differences in PEF between early morning and evening.. Of 55 patients suffering from chronic cough, 23 satisfied the criteria for CVA. Their cough occurred more frequently at night and early in the morning. Early morning PEF was significantly lower than evening PEF with a mean variability of 11.5 +/- 4.1%. Treatment with beclomethasone propionate improved coughing and significantly increased early morning PEF, reducing variability to less than 10%.. These findings suggest that CVA is most common among patients with chronic cough not due to any apparent cause. The efficacy of inhaled corticosteroid suggests that early intervention is effective in the treatment of CVA.

Topics: Administration, Inhalation; Asthma; Beclomethasone; Chronic Disease; Circadian Rhythm; Cough; Female; Follow-Up Studies; Forced Expiratory Volume; Glucocorticoids; Hospitals, General; Humans; Japan; Male; Middle Aged; Outpatient Clinics, Hospital; Prevalence; Prospective Studies; Treatment Outcome

Allergic rhinitis is a common cause of chronic cough. Topical corticosteroids are regarded as the most effective first-time treatment in allergic rhinitis. In this study we evaluated the cough sensitivity during the early and late allergic responses in guinea pigs with experimental allergic rhinitis. Another aim of the study was to follow up the effect of inhaled beclomethasone dipropionate on the cough in guinea pigs with allergic rhinitis. 31 guinea pigs were sensitized with ovalbumin (OA). Animals were intranasally challenged with OA (experiment) or saline (control) in 7-day intervals for 9 weeks. Cough was induced by inhalation of citric acid aerosols in gradually increasing concentrations for 30 s and was evaluated 1 h after the 8(th) nasal challenge (NCH) and 17 h after the 9(th) NCH. Cough was significantly increased only during an early allergic response, 1 h after repeated NCH [18 (14-23) vs. 8 (3-10); P<0.001]. Five experimental animals were inhaling aerosol of beclomethasone dipropionate seven days between the 8(th) and the 9(th) NCH and cough was evaluated 1 h after the 9(th) NCH. Inhaled corticosteroids significantly inhibited the enhanced allergic rhinitis related cough [4 (1-9) vs.19 (9-37) vs. 6 (3-9); P<0.05].

Topics: Administration, Inhalation; Aerosols; Animals; Anti-Inflammatory Agents; Beclomethasone; Bronchial Provocation Tests; Citric Acid; Cough; Guinea Pigs; Male; Ovalbumin; Rhinitis

We have described a group of patients who present with isolated chronic bronchodilator resistant non-productive cough with an atopic constitution, eosinophilic tracheobronchitis, and airway cough receptor hypersensitivity without bronchial hyperresponsiveness, which we have termed "atopic cough". Although cough variant asthma (in which the cough responds to bronchodilators) is recognised as a precursor of typical asthma, it is not known whether atopic cough is also a precursor of asthma.. Eighty two patients with atopic cough were retrospectively examined for onset of typical asthma and compared with 55 patients with cough variant asthma (20 untreated patients and 35 treated with long term inhaled beclomethasone dipropionate (BDP), 218-467 micro g/day). The median follow up period for patients with atopic cough and cough variant asthma was 4.8 (1-11.5) years and 3.7 (1-12.4) years, respectively.. Onset of typical asthma occurred in only one of the patients with atopic cough. In patients with cough variant asthma, typical asthma developed in two of 35 patients taking BDP and six of 20 untreated patients (difference 24.3%, 95% CI 2.8 to 45.8, p<0.02).. These findings suggest that cough variant asthma is a precursor of typical asthma but that atopic cough is not. Treatment with inhaled steroids may prevent the transformation of cough variant asthma into typical asthma.

Topics: Administration, Inhalation; Adolescent; Adult; Anti-Asthmatic Agents; Asthma; Beclomethasone; Bronchodilator Agents; Cough; Drug Resistance; Female; Forced Expiratory Volume; Humans; Male; Middle Aged; Recurrence; Retrospective Studies; Vital Capacity

Cough variant asthma and atopic cough are different clinical manifestations of eosinophilic airway inflammation presenting with isolated chronic non-productive cough. The aim of this study was to examine the longitudinal change in pulmonary function in cough variant asthma and atopic cough.. Longitudinal change in FEV1 was prospectively examined in 20 patients with cough variant asthma, 14 patients with atopic cough and 271 asymptomatic healthy subjects. All were lifetime non-smokers. Of the 20 cough variant asthma patients, 13 were taking long-term inhaled corticosteroid therapy (ICS) (beclomethasone dipropionate 615 +/- 58 micro g/day) and the other seven were not. Spirometry was taken at first visit, after cough was almost completely relieved on therapy, and at least once every year for 5 or more years afterwards.. The slope of longitudinal change in FEV1 was not significantly different among cough variant asthma patients (- 0.029 +/- 0.007/year), atopic cough patients (- 0.021 +/- 0.022/year) and asymptomatic subjects (- 0.028 +/- 0.002 L/year). In patients with cough variant asthma, the slope in patients not taking inhaled corticosteroids (ICS) was 0.032 +/- 0.007 L/year, which was not significantly different from that in patients taking ICS (- 0.027 +/- 0.010 L/year).. Pulmonary function decline is not greater in cough variant asthma than atopic cough and the normal population, and long-term ICS has no effect on the decline in cough variant asthma.

Topics: Asthma; Beclomethasone; Cough; Female; Forced Expiratory Volume; Glucocorticoids; Humans; Hypersensitivity, Immediate; Longitudinal Studies; Lung; Male; Middle Aged; Prospective Studies; Vital Capacity

Children using a spacer device rather than another device for delivering inhaled corticosteroids (ICS) has been identified as a risk factor for cough immediately after inhalation. The aim of this study was to point out the different factors influencing the occurrence of such lateral side-effects. We studied this local side-effect in 402 asthmatic children (55.6 +/- 34.9 months; 65.6% boys) treated for at least 1 month with beclomethasone dipropionate (n = 331), budesonide (n = 47) or fluticasone propionate (n = 24) delivered from pressurized metered-dose inhalers and small (75.1%) or large volume (24.8%) spacer devices mainly used with face mask (90.7%). A total of 219 patients (54.5%), treated with either high doses of ICS or ICS and long-acting beta2-agonist, were considered as having severe asthma. Cough was reported after each inhalation of corticosteroids in 216 patients (53.7%). Among them, about 30% also complained of cough with beta2-agonists. Despite different propellants and dispersants, all corticosteroids induced cough similarly. Cough was not linked with asthma severity, but was significantly related to therapy duration and use of long-acting beta2-agonist. Type and volume of the spacer device, use of a face mask or mouthpiece were not influencing factors. Cough after inhalation of corticosteroids delivered from spacer devices is a frequent local side-effect in children with asthma. This side effect can greatly alter compliance. A practitioner must be sought at each visit.

Topics: Administration, Inhalation; Adolescent; Asthma; Beclomethasone; Chi-Square Distribution; Child; Child, Preschool; Confidence Intervals; Cough; Drug Delivery Systems; Female; Humans; Infant; Male; Metered Dose Inhalers

Endogenously released nitric oxide (NO) has been detected in the exhaled air of humans. Exhaled NO (NOexh) levels have been significantly increased in patients with inflammatory airways disorders such as asthma, and NOexh has been suggested to be a usable marker of airway inflammation. In the present study, NOexh levels were measured both in steroid-treated and untreated subjects with mild asthma, and were correlated with the degree of airway hyperresponsiveness (AHR), measured as the dose of histamine that produced a 20% decrease in FEV1 (PC20histamine). NOexh levels, which were significantly increased in steroid-naive patients (Group A1: NOexh = 21 +/- 11 ppb; n = 56) in comparison with levels in control subjects (Group B: NOexh = 10 +/- 2 ppb; n = 20; p < 0.001), correlated significantly with the PC20histamine (r = -0.65; p < 0.0001). The NOexh level was significantly lower in patients with chronic cough of other causes than bronchial asthma (Group A2: NOexh = 11 +/- 3 ppb; n = 18) when compared with the level in subjects with mild asthma (Group A1: p < 0.001). Therefore, the noninvasive measurement of NOexh allowed us to discriminate, among patients with respiratory complaints, between those with and without AHR. In asthmatic subjects treated with inhaled steroids, the NOexh levels were significantly lower (Group A3: NOexh = 13 +/- 5 ppb; n = 25) than in untreated subjects (Group A1; p < 0.01), and there was no relationship with the PC20histamine (r = -0.18, p = NS). These findings confirm that NOexh reflects AHR in patients with mild asthma who have not already been treated with inhaled steroids. Patients treated with inhaled steroids had an NOexh level comparable to levels in control subjects, although AHR could still be demonstrated.

Topics: Adrenergic beta-Agonists; Adult; Airway Obstruction; Anti-Asthmatic Agents; Anti-Inflammatory Agents; Asthma; Beclomethasone; Biomarkers; Bronchial Hyperreactivity; Bronchial Provocation Tests; Chronic Disease; Cough; Dyspnea; Female; Forced Expiratory Volume; Glucocorticoids; Histamine; Humans; Male; Nitric Oxide; Respiration; Respiratory Sounds

The aim of the study was to assess the prevalence of throat and voice symptoms in asthma patients using pressurized aerosol, metered-dose, inhaled corticosteroid preparations. A questionnaire was administered to hospital out-patients in an asthma clinic and to a control group attending a diabetic clinic. Two hundred and fifty five consecutive out-patients using pressurized aerosol inhaled corticosteroids and 100 controls were surveyed. One hundred and forty seven (58%) patients taking inhaled steroids reported voice dysphonia or throat symptoms compared with 13% of control patients. Women admitted to symptoms more frequently than men. Throat symptoms were more prevalent in patients using higher doses of inhaled steroid. Aerosol inhaler-induced cough was reported by 87 (34%) patients. Local side-effects were equally prevalent both with beclomethasone dipropionate and budesonide aerosol inhalers. The use of a large volume spacing device with either steroid aerosol did not appear to protect against these symptoms. Local side-effects are common in asthmatics taking pressurized aerosol, metered-dose, inhaled steroids.

Topics: Aerosols; Anti-Inflammatory Agents; Asthma; Beclomethasone; Budesonide; Case-Control Studies; Cough; Female; Humans; Male; Middle Aged; Nebulizers and Vaporizers; Outpatient Clinics, Hospital; Pregnenediones; Prevalence; Surveys and Questionnaires; Voice Disorders

Topics: Albuterol; Beclomethasone; Cough; Humans

A double-blind crossover trial comparing the clinical efficacy of intranasal beclomethasone dipropionate and intranasal sodium cromoglycate was carried out in fourteen patients with perennial rhinitis due to animal danders. Intranasal beclomethasone dipropionate was significantly more effective than intranasal sodium cromoglycate in relieving nasal obstruction, nasal discharge and sneezing. Eleven patients reported preference for beclomethasone dipropionate and three had no preference for either drug.

Topics: Adolescent; Adult; Airway Obstruction; Beclomethasone; Cough; Cromolyn Sodium; Double-Blind Method; Female; Humans; Male; Middle Aged; Nasal Mucosa; Rhinitis, Allergic, Perennial; Sneezing

Topics: Adolescent; Asthma; Beclomethasone; Bronchi; Bronchial Diseases; Bronchitis; Child; Child, Preschool; Cough; Drug Tolerance; Female; Follow-Up Studies; Humans; Male; Nasal Cavity; Rhinitis, Allergic, Seasonal; Spasm