fluticasone and Bronchitis--Chronic

Population-based studies have shown a significant heterogeneity in patients with chronic obstructive pulmonary disease (COPD), regarding both the attainment of maximal lung function and the subsequent decline over time. This review will highlight recent advances in the understanding of lung function trajectory in COPD, focusing on factors that influence peak adult lung function, markers of accelerated lung function decline and pharmacologic interventions in early phases of the disease.. Recent data have shown that individuals with lower lung function early in life will go on to develop lower forced expiratory volume in 1 s (FEV1) in adulthood. Smoking can amplify the effect of specific childhood exposures on maximal adult lung function. Clinical symptoms such as chronic mucous hypersecretion and the biomarker club cell secretory protein have been associated with lung function decline over time. New computed tomography imaging markers also show promise as a way to detect early small airway disease, but need to be examined more longitudinally. In addition to these advances, a slower decline in FEV1 has been demonstrated in two randomized clinical trials studying tiotropium and inhaled fluticasone.. A better understanding of lung function development and eventual decline in those at risk for progression to COPD will aide in a precision medicine approach, in which markers for those at risk of low maximal lung function and accelerated decline are identified. Targeted therapy can then be used early to modify disease activity and outcomes.

Topics: Biomarkers; Bronchitis, Chronic; Bronchodilator Agents; Disease Progression; Fluticasone; Forced Expiratory Volume; Humans; Pulmonary Disease, Chronic Obstructive; Smoking; Tiotropium Bromide; Tomography, X-Ray Computed; Uteroglobin

Increased oxidative stress and bronchial inflammation are important mechanisms in the pathophysiology of COPD.. To investigate whether treatment with the inhaled corticosteroid fluticasone propionate (FP) or the anti-oxidative agent N-acetylcysteine (NAC) are effective in primary care patients.. The study was a 3-year placebo-controlled randomised controlled trial preceded by a 3-month washout and 2-week prednisolone pre-treatment. Patients were (ex-)smokers with chronic bronchitis or COPD. Interventions were inhaled FP 500microg b.i.d., oral NAC 600mg o.d., or placebo. Exacerbation rate and quality of life measured with the Chronic Respiratory Questionnaire (CRQ) were the primary outcomes, FEV(1) decline and respiratory symptoms secondary outcomes.. 286 patients recruited from 44 general practices were randomised. Exacerbation rate was 1.35 times higher for NAC (p=0.054) and 1.30 times higher for FP (p=0.095) compared with placebo. CRQ total scores did not differ between NAC (p=0.306) or FP (p=0.581) treatment compared to placebo. Annual postbronchodilator FEV(1) decline was 64mL [SD 5.4] for NAC [p=0.569 versus placebo], 59mL [SD 5.7] for FP [p=0.935], and 60mL [SD 5.4] for placebo.. No beneficial treatment effects for either high-dosed inhaled fluticasone propionate or oral N-acetylcysteine were observed in our study population of patients with COPD or chronic bronchitis.

Topics: Acetylcysteine; Adult; Aged; Androstadienes; Bronchitis, Chronic; Bronchodilator Agents; Expectorants; Female; Fluticasone; Forced Expiratory Volume; Humans; Male; Middle Aged; Netherlands; Primary Health Care; Pulmonary Disease, Chronic Obstructive; Quality of Life; Smoking; Treatment Outcome

Basic lung and heart ultrasound examination combined with chest X-ray (TUSX) is currently considered to be very useful for differentiation of asthma, chronic bronchitis and laryngeal paralysis from other diseases with dyspnea/coughing. Among 252 client-owned animals with persistent dyspnea/cough/noisy breathing, in 197 of them: pulmonary edema, pneumonia, lung cancer, free pleural fluid, pneumothorax, lung contusion or heart disease were diagnosed. The remaining 55 animals (42 dogs and 13 cats) were diagnosed with asthma (in 13 cats), chronic bronchitis (in 37 dogs) and laryngeal paralysis (in 5 dogs) using TUSX. These animals were qualified for inhaled fluticasone treatment using 3 types of spacers - two commercial and a home- -made mask. 36 animals (65.5%) completed the trail. In 26 of them (72.2%) the owners observed complete, long lasting relief of the symptoms, and the owners of 7 animals (19.5%) declared a considerable clinical improvement, regardless of the type of spacer used. The owners of 3 animals (8.3%) did not see any improvement. The proposed diagnostic and therapeutic management improved long-term clinical status of the vast majority (91.7%) of animals. Therefore, it seems justified to include the TUSX diagnostic protocol in daily veterinary practice and to encourage owners to prepare home-made face masks for inhaled fluticasone treatment.

Topics: Animals; Asthma; Bronchitis, Chronic; Cat Diseases; Cats; Dog Diseases; Dogs; Dyspnea; Fluticasone; Lung; Vocal Cord Paralysis; X-Rays

An 11-year-old, castrated male Shetland Sheepdog presented for a 3-week history of localized nonpruritic alopecia and scaling affecting the peri-nasal region. The dog was being managed for several comorbidities, including chronic bronchitis successfully controlled with the chronic administration of inhaled fluticasone propionate. The physical examination was unremarkable aside from erythema, symmetrical alopecia, scaling and follicular casts affecting the peri-nasal region. Deep skin scrapings and histopathological examination from the lesional skin revealed several live demodex mites consistent with Demodex canis. Transcriptome analysis of lesional skin demonstrated significant downregulation of several cytokines involved in the T helper (Th) 2 and Th17 pathway with moderate upregulation of Th1 cytokine IFN-γ and T-cell recruitment chemokine CXCL10. The dog was immediately treated with oral fluralaner. Clinical signs of demodicosis resolved after 8 weeks and a trichogram was negative for live and/or dead demodex mites. The dog has remained on twice-daily administration of inhaled fluticasone and oral fluralaner every 3 months for 15 months without a demodicosis relapse, in addition to medication to manage the dog's comorbidities. To the author's knowledge, this is the first case of localized demodicosis caused by an inhaled glucocorticoid in a dog.

Topics: Animals; Bronchitis, Chronic; Dog Diseases; Dogs; Fluticasone; Male

This study investigated the effect of inhaled fluticasone on lower airway inflammation and bronchial responsiveness (BR) to inhaled carbachol in cats with very mild, chronic bronchitis (n = 5) that were compared with healthy cats serving as controls (n = 6). Chest radiographs, BR tests performed non-invasively by barometric whole body plethysmography (BWBP) and bronchoalveolar lavage (BAL) were performed before and after treatment. BR was quantified by calculating the concentration of carbachol inducing bronchoconstriction (C-Penh300%), defined as a 300% increase of baseline Penh, an index of bronchoconstriction obtained by BWBP. BAL fluid was analyzed cytologically and the oxidant marker 8-iso-PGF2alpha was determined. At test 1, healthy cats and cats with bronchitis were untreated, whereas for test 2 inhalant fluticasone (250 microg once daily) was administrated for 2 consecutive weeks to cats with bronchitis. Control cats remained untreated. Inhaled fluticasone induced a significant increase in C-Penh300% and a significant decrease of BAL fluid total cells, macrophages, neutrophils and 8-iso-PGF2alpha in cats with bronchitis, whilst untreated control cats did not show significant changes over time. This study shows that a 2-week fluticasone treatment significantly reduced lower airway inflammation in very mild bronchitis. BR could be successfully monitored in cats using BWPB and decreased significantly in response to inhaled fluticasone. 8-Iso-PGF2alpha in BAL fluid was responsive to treatment and appeared as a sensitive biomarker of lower airway inflammation in cats.

Topics: Administration, Inhalation; Androstadienes; Animals; Anti-Inflammatory Agents; Bronchitis, Chronic; Bronchoalveolar Lavage Fluid; Bronchodilator Agents; Case-Control Studies; Cat Diseases; Cats; Female; Fluticasone; Male; Plethysmography; Treatment Outcome