fluticasone and Cough

This study aimed to evaluate the efficacy and safety of montelukast (Mon) + fluticasone propionate (Flu) versus Flu in the treatment of cough variant asthma (CVA) in children.. Eligible documents were selected from various databases. Weighted mean difference (WMD) and 95% confidence interval (CI) were used to evaluate continuous variables, and categorical variables were evaluated using risk ratio (RR) and 95% CI. Heterogeneity analysis was performed using Cochran's Q test and I. Nine studies were included, and Flu + Mon was found to significantly improve the total effective rate and reduce cough recurrence compared to Flu. The cough remission and disappearance times in the Mon + Flu group were significantly lower than those in the Flu group. FEV1% recovery in the Mon + Flu group was significantly better than that in the Flu group.. Mon + Flu is effective and safe for the treatment of CVA in children.

Topics: Acetates; Androstadienes; Anti-Asthmatic Agents; Asthma; Child; Cough; Cyclopropanes; Fluticasone; Humans; Quinolines

Topics: Adrenergic beta-Agonists; Albuterol; Androstadienes; Asthma; Chronic Disease; Clenbuterol; Cough; Drug Therapy, Combination; Fluticasone; Histamine H1 Antagonists; Humans; Hypersensitivity, Immediate; Phthalazines; Prednisolone

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

Glucocorticoids are frequently required for management of cough because of inflammatory airway disease (IAD) and airway collapse (AWC).. To determine the efficacy and feasibility of inhaled administration of corticosteroids in controlling cough in dogs with noninfectious airway disease.. Thirty-six client-owned dogs.. Dogs were prospectively recruited for this placebo-controlled cross-over study. Inflammatory airway disease was diagnosed through bronchoalveolar lavage cytology. Airway collapse was diagnosed through bronchoscopy, or if dogs were unsuitable anesthetic candidates, by crackles on auscultation, radiographic changes in airway diameter, or fluoroscopy. Dogs were randomly assigned to receive placebo or fluticasone propionate for the first 2 weeks of the trial then crossed over to fluticasone. A quality of life (QOL) survey (best score 0, worst score 85) was completed at 0 and 6 weeks. A visual-analog cough survey was submitted at 0, 2, 4, and 6 weeks to assess cough, feasibility, and adverse effects of treatment.. For 32 dogs, QOL score at study end (mean 11.3 ± 9.7) was significantly lower (P < .0001) compared to entry (mean 28.1 ± 14.1), with a median change of 69% in QOL score, indicating improved quality of life. Cough frequency, duration, and severity were significantly (P < .0001) decreased at study end. Feasibility of aerosolized delivery improved with continued use (P = .05) with only 1 dog unable to accept inhaled medication.. This study supports the utility of fluticasone propionate by inhalation in management of cough in dogs with IAD and AWC.

Topics: Androstadienes; Animals; Asthma; Cough; Cross-Over Studies; Dog Diseases; Dogs; Double-Blind Method; Fluticasone; Glucocorticoids; Quality of Life

This study was to evaluate the clinical efficacy and safety of fluticasone/ salmeterol inhalation powder plus Huaiqihuang Granules for children with cough variant asthma (CVA). From June 2019 to May 2021, 60 children with CVA were hospitalized to the Pediatrics Department of Cangzhou Central Hospital and randomized to the observation (fluticasone/salmeterol inhalation powder plus huaiqihuang granules) and control group (fluticasone/salmeterol inhalation powder) using the random number table method. The outcome measures include clinical efficacy, forced vital capacity (FVC), forced expiratory volume per second (FEV1), peak expiratory flow (PEF), FeNO, high-sensitivity C-reactive protein (hs-CRP), interleukin-17 (IL-17) and IL-23, airway anatomical indicators and T lymphocyte subsets levels. Both groups exhibited remarkable improvements in FVC, FEV1, PEF and FeNO and hs-CRP, IL-17 and IL-23, with higher FVC, FEV1 and PEF and lower FeNO, hs-CRP, IL-17 and IL-23 in the observation group (all P<0.05). Significantly higher levels of CD4+ and CD4+/CD8+ were observed in the observation group versus control group, but lower airway wall thickness, basement membrane thickness, total airway wall area and CD8+ in the observation group (all P<0.05). Fluticasone/salmeterol inhalation powder plus Huaiqihuang Granules improves lung function, FeNO and airway inflammation in children with CVA and boosts cellular and humoral immune function.

Topics: Asthma; C-Reactive Protein; Child; Cough; Fluticasone; Humans; Interleukin-17; Interleukin-23; Powders; Salmeterol Xinafoate; Treatment Outcome

To study the clinical effect of different combinations of fluticasone propionate (Flu), montelukast sodium (Mon) and ketotifen (Ket) in the treatment of children with cough variant asthma (CVA).. A total of 280 children with CVA who were admitted to the department of respiratory medicine from June 2015 to January 2018 were randomly divided into Flu+Mon+Ket, Flu+Mon, Flu+Ket, Mon+Ket, Flu, Mon and Ket groups, with 40 children in each group. The children in each group were given corresponding drug(s), and the course of treatment was 3 months for all groups. The condition of cough, cough symptom score, pulmonary function and adverse drug reactions were evaluated after 2 and 3 months of treatment. The children were followed up to observe recurrence.. After treatment, cough symptom score tended to decrease in all 7 groups, with increases in percentage of forced expiratory volume in 1 second (FEV1%) and percentage of predicted peak expiratory flow (PEF%). After 2 months of treatment, the Flu+Mon+Ket group had a significantly lower cough symptom score and significantly higher FEV1% and PEF% than the other groups (P<0.05). After 2 and 3 months of treatment, the Ket group had a significantly higher cough symptom score and significantly lower FEV1% and PEF% than the other groups (P<0.05). After 3 months of treatment, there were no significant differences in cough symptom score, FEV1% and PEF% among the other groups (P>0.05). There was a low incidence rate of adverse events in all 7 groups, and there was no significant difference among the 7 groups (P>0.05). The Ket group had a significantly higher recurrence rate of cough than the other groups (P<0.001), while there was no significant difference in this rate among the other groups (P>0.0024).. For children with CVA, a combination of Flu, Mon and Ket has a better clinical effect than a combination of two drugs and a single drug at 2 months of treatment and is safe. After 3 months of treatment, Flu or Mon alone has a similar effect to drug combination. Ket alone has a poor clinical effect and a high recurrence rate after drug withdrawal.

Topics: Acetates; Androstadienes; Anti-Asthmatic Agents; Asthma; Child; Cough; Cyclopropanes; Drug Combinations; Fluticasone; Humans; Ketotifen; Quinolines; Sulfides

Upper airway inflammation is one of the most commonly identified causes of chronic cough, although the underlying mechanism is not clear. This study compared normal saline solution nasal-pharyngeal irrigation (NSNPI) and fluticasone propionate nasal spray (FPNS) treatment for chronic cough associated with allergic rhinitis (AR).. Patients with suspected AR to house-dust mite were enrolled, and the symptom of cough was assessed by a cough symptom score and the Leicester Cough Questionnaire, and cough response to capsaicin was evaluated. AR was assessed by using the visual analog scale (VAS) and the Mini Juniper Rhinoconjunctivitis Quality of Life Questionnaire (MiniRQLQ). Mediators, including histamine, leukotriene C4, and prostaglandin D2, and the major basic protein from nasal lavage fluid (NLF) were examined. The patients were treated with NSNPI (the NSNPI group) or FPNS (the FPNS group) for 30 days, after which they were reassessed.. Forty-five of 50 patients completed this study. The scores of the cough symptom and the Leicester Cough Questionnaire, and the capsaicin cough threshold all improved statistically after NSNPI but did not change after FPNS. There were statistically significant changes in the evaluations of the MiniRQLQ and the mediators, including histamine and leukotriene C4, in the NLF in the NSNPI group. However, significant changes were found in the assessments of VAS, MiniRQLQ, and all above mediators including histamine, leukotriene C4, and prostaglandin D2, and the major basic protein in the NLF of the FPNS group. Furthermore, the assessments of VAS and all the mediators were reduced more in the FPNS group compared with those in the NSNPI group.. The patients with suspected AR to house-dust mite reported a better relief of the cough symptom after 30 days of treatment with NSNPI compared with that after nasal corticosteroid.

Topics: Adenoids; Adolescent; Adult; Aged; Animals; Antigens, Dermatophagoides; Chronic Disease; Cough; Fluticasone; Humans; Middle Aged; Nasal Sprays; Paranasal Sinuses; Pyroglyphidae; Rhinitis, Allergic; Sodium Chloride; Therapeutic Irrigation; Young Adult

Nonallergic vasomotor rhinitis (NAVMR) has been considered a diagnosis by exclusion due to unknown mechanisms or lack of diagnostic biomarkers.. To determine clinical responses and biological pathways in NAVMR subjects challenged to cold dry air (CDA) in an environmental exposure chamber (EEC) pre- and posttreatment with azelastine/fluticasone (AzeFlu), 30 NAVMR subjects, prescreened for CDA-induced symptoms (approx. 14°C, <15% relative humidity, ×1 h) were randomized to treatment with AzeFlu (n = 20) or placebo (n = 10) for 2 weeks. Total nasal symptoms scores, minimum cross-sectional area, cough, and conjunctival redness were recorded at visit 1 (pretreatment) and visit 2 (posttreatment) before, during, and after CDA challenge. At both visits, nasal lavage fluid (NLF) and nasal scrapings (NS) were collected pre- and post-CDA challenge. Substance P, neurokinin-A, and calcitonin gene-related peptide concentrations in NLF were analyzed pre- and postchallenge at each visit. Their relationship with CDA-induced symptoms was determined by statistical analysis. MicroRNA sequencing from NS determined differentially expressed miRNA between the treatment groups post-CDA challenge at each visit.. The minimum cross-sectional area (p < 0.05), cough count (p < 0.05), and substance P (p < 0.01) improved posttreatment with AzeFlu versus placebo. Gene targets for differentially expressed miRNAs at visit 1 were enriched for biological pathways regulating epithelial ciliogenesis and cell integrity that were modified in the AzeFlu-treated group versus placebo posttreatment.. This study demonstrated the feasibility of an EEC model to investigate CDA-induced clinical responses and pathobiology in NAVMR subjects pre- and posttreatment with AzeFlu. NAVMR disease mechanisms for other nonallergic triggers can be investigated similarly.

Topics: Adult; Air; Anti-Inflammatory Agents; Bronchial Provocation Tests; Cold Temperature; Cough; Female; Fluticasone; Humans; Male; MicroRNAs; Middle Aged; Nasal Mucosa; Phthalazines; Pilot Projects; Rhinitis, Vasomotor

Treatment of canine idiopathic eosinophilic bronchopneumopathy mainly consists of long-term oral corticosteroid therapy. To avoid side effects, inhaled steroid therapy has been increasingly used but long-term clinical response and potential side effects are sparsely described.. Description of clinical response and side effects with long-term fluticasone in dogs with eosinophilic bronchopneumopathy.. Case series of dogs with eosinophilic bronchopneumopathy and treated with fluticasone monotherapy for at least 6 months. Clinical response and side effects assessed by physical examination, standardised questionnaire and ACTH (corticotropin) stimulation test.. Eight dogs were treated for between 6 months and 5 years. Cough initially improved in all dogs; two dogs remained free of clinical signs, three were well controlled, but three showed severe relapse. Pituitary-adrenal axis inhibition occurred in two dogs treated with fluticasone monotherapy for more than 2 years; only one dog had clinical signs of iatrogenic hyperadrenocorticism.. Fluticasone monotherapy allows initial improvement or remission in the majority of dogs but long-term treatment fails to resolve the cough in some individuals. In addition, such therapy may induce pituitary-adrenal axis inhibition. Prospective larger and randomised studies including both fluticasone and orally-treated dogs are needed to define the optimal treatment.

Topics: Administration, Inhalation; Animals; Bronchodilator Agents; Bronchopneumonia; Cough; Dog Diseases; Dogs; Female; Fluticasone; Follow-Up Studies; Male; Pulmonary Eosinophilia

Sore throat is a common complication after surgery. Postoperative cough and hoarseness can also be distressing to patients. We sought to determine the effect of an inhaler steroid on sore throat, cough, and hoarseness during the first 24 hours of the postoperative period.. We enrolled 120 women with ASA physical status I or II and term singleton pregnancy who were scheduled for elective cesarean delivery under general anesthesia. Patients were randomized into 2 groups: in the sitting position, group F patients received 500 μg inhaled fluticasone propionate via a spacer device during 2 deep inspirations, after arrival in the operating room, and group C had no treatment. The patients were interviewed by a blinded investigator for postoperative sore throat, cough, and hoarseness at 1 and 24 hours after surgery.. There were no significant differences in age, height, weight, body mass index, duration of surgery, intubation, and grade of laryngeal exposure between the 2 groups. The incidence of sore throat, cough, and hoarseness was significantly lower in group F (3.33%, 3.33%, and 3.33%) compared with the control group (36.67%, 18.33%, and 35%) (P < 0.05 for all comparisons), not only in the first postoperative hour but also 24 hours after surgery (13.33%, 13.33%, and 25% in group F vs 40%, 41.67%, and 50% in the control group). The incidence of moderate and severe hoarseness in group F at the first hour was significantly less than the control group (P < 0.05).. Inhaled fluticasone propionate decreases the incidence and severity of postoperative sore throat, cough, and hoarseness in patients undergoing cesarean delivery under general anesthesia.

Topics: Administration, Inhalation; Adult; Androstadienes; Anesthesia, General; Cesarean Section; Cough; Female; Fluticasone; Hoarseness; Humans; Pharyngitis; Postoperative Complications; Pregnancy; Prospective Studies; Single-Blind Method; Young Adult

The systemic exposure of fluticasone propionate with hydrofluoroalkane propellant compared with chlorofluoro-carbon propellant and the effect of fluticasone propionate hydrofluoroalkane on 24-hour urinary cortisol in children aged 4 to 11 years with asthma were evaluated. Study 1 was an open-label, 2-way crossover study in which 16 subjects were randomized to 7.5 days each of fluticasone propionate hydrofluoroalkane 88 mug twice a day or fluticasone propionate chlorofluorocarbon 88 mug twice a day. In study 2, 63 subjects received 13.5 days of placebo followed by 27.5 days of fluticasone propionate hydrofluoroalkane 88 mug twice a day. The main outcome measure for study 1 was the difference between fluticasone propionate hydrofluoroalkane and fluticasone propionate chlorofluorocarbon in fluticasone propionate AUC(last) (area under the plasma fluticasone propionate concentration-time curve from zero up to the last quantifiable plasma concentration), and for study 2, 24-hour overnight urinary cortisol excretion. In study 1, fluticasone propionate systemic exposure was significantly lower (55%) with hydrofluoroalkane metered dose inhaler compared with chlorofluorocarbon metered dose inhaler. Study 2 showed no statistically significant changes in 24-hour overnight urinary cortisol excretion and no relationship to fluticasone propionate systemic exposure at this dose. The results of these 2 studies showed that in children aged 4 to 11 years with asthma, fluticasone propionate hydrofluoroalkane has lower systemic exposure compared with chlorofluorocarbon and no hypothalamic-pituitary-adrenal axis effects as measured by 24-hour urinary cortisol excretion.

Topics: Administration, Inhalation; Aerosol Propellants; Androstadienes; Anti-Asthmatic Agents; Area Under Curve; Asthma; Child; Child, Preschool; Chlorofluorocarbons; Cough; Cross-Over Studies; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Fever; Fluticasone; Half-Life; Headache; Humans; Hydrocarbons, Fluorinated; Hydrocortisone; Male; Metered Dose Inhalers; Nausea; Respiratory Tract Infections

The effects of inhaled steroids upon the quality of life of patients with bronchiectasis remain unknown.. To analyze the effect of inhaled fluticasone propionate (FP) for 6 months upon the clinical, functional, microbiological and outcome parameters of patients with steady-state bronchiectasis not due to cystic fibrosis, and its repercussions for patient health-related quality of life (HRQoL).. Prospective, randomized, double-blind (for effective doses) study.. The diagnosis of bronchiectasis was made by high-resolution computed tomography. Ninety-three patients (mean age: 68.5 [8.4]) were randomized to receive 250 microg bid, 500 microg bid or no treatment with inhaled FP for 6 months. Data were collected at baseline and at 1, 3 and 6 months after the start of treatment. HRQoL was assessed using the validated Spanish version of the St. George's Respiratory Questionnaire.. The group administered FP 1000 microg daily showed significant improvement in dyspnea (1.03 [2.1]-1.24 [2.2] points; P = 0.01-0.04), sputum production (P = 0.001), days without cough (P = 0.02) and short-acting beta-2 agonists used (P = 0.01) from the first month of treatment, with no changes in pulmonary function, number or severity of exacerbations, or microbiological profile of the sputum. As a result, an improvement in HRQoL was seen in this group after 3 months of treatment (45.4 [14.2] vs. 40.5 [13.9]; P = 0.01).. Inhalatory FP 500 microg bid is effective from the first month of treatment for controlling the symptoms of patients with steady-state bronchiectasis-thus ensuring a significant improvement in HRQoL.

Topics: Administration, Inhalation; Aged; Androstadienes; Bronchiectasis; Bronchodilator Agents; Cough; Double-Blind Method; Dyspnea; Female; Fluticasone; Forced Expiratory Volume; Humans; Male; Prospective Studies; Quality of Life; Respiratory Sounds; Vital Capacity

Aims of this study were: to evaluate changes in lung function in wheezing children with detected MP and CP infection according to treatment; to measure the response to inhaled corticosteroids in children with significant wheezing who were selected as having a high risk of progressing into childhood asthma. 54 children were randomly assigned 2:1 into 2 groups-the main group (36 patients), in which inhaled corticosteroids were administered, and the control group (18 patients), without inhaled corticosteroids. Serum IgE levels were determined using the ELISA (reagents: IBL-Hamburg). Serologic studies were performed by the ELISA for IgM and IgG antibodies to MP and for IgG and IgA antibodies to CP (reagents: ImmunoLISA, Orgenics, Israel) on the Hiperion MRIII (USA). Pulmonary function testing was done with SpiroLab II (DEGO GmbH, Medizin-Elektronik, Germany). The patients of both groups were administered macrolides: azitromycin during five days. Patients of the first group received inhaled fluticasone propionate 125 mg twice daily. The parents were asked to record symptoms. Each symptom (wheezing, cough, and shortness of breath) were scored on a scale of 0 to 3--daily symptom score (DSS). Scores were calculated every 4 weeks for a total treatment period 16 weeks. The days within each period on which the DSS equalled zero were pointed as symptom free days (SFD). It had been shown an significant improvement in DSS, an increase in SFD and significant improvement of the lung functions following the treatment with inhaled fluticasone and macrolide in children with wheezing and documented MP or CP infection, compared to control group treated only with antibiotics. In conclusion, the use of ICS should be seriously considered in children with wheezing and the risk of persisting symptoms.

Topics: Administration, Inhalation; Androstadienes; Anti-Inflammatory Agents; Child; Child, Preschool; Cough; Enzyme-Linked Immunosorbent Assay; Female; Fluticasone; Humans; Immunoglobulin E; Immunoglobulin G; Immunoglobulin M; Lung; Male; Respiratory Sounds

Cough may be the consequence of bronchial hyperresponsiveness (BHR) and inflammation. This study was designed to investigate the short-term effects of an inhaled steroid (fluticasone propionate (FP)) on cough, and to determine the effects of smoking, BHR, allergy and forced expiratory volume in one second (FEV1) on the efficacy of FP. In a community-based primary healthcare centre, 135 previously healthy adults suffering from cough for > or =2 weeks were enrolled in a randomised, double-blind, placebo-controlled trial of inhaled FP 500 microg b.i.d. for 2 weeks. Participants completed daily diary cards of lower respiratory tract symptoms. The primary outcome measure was the decrease in mean total daily cough score (0-6) during the second week of treatment. In the FP group, the cough score decreased from 3.8 at baseline to mean+/-SEM 1.4+/-0.2 during the second week. In the placebo group, this decrease was from 3.8 to 1.9+/-0.1 and was statistically significantly less. A favourable effect of FP was only detectable in nonsmokers, in whom the score was 0.9 points lower compared with placebo. The clinical relevance of this finding has to be established further. Allergy, FEV1 and BHR at baseline did not affect the efficacy of FP. In conclusion, anti-inflammatory treatment with the inhaled steroid fluticasone propionate reduces cough in otherwise healthy adults who do not smoke.

Topics: Administration, Inhalation; Adolescent; Adult; Aged; Androstadienes; Anti-Inflammatory Agents; Bronchial Hyperreactivity; Chronic Disease; Cough; Dose-Response Relationship, Drug; Double-Blind Method; Drug Administration Schedule; Female; Fluticasone; Follow-Up Studies; Humans; Male; Middle Aged; Probability; Reference Values; Risk Assessment; Severity of Illness Index; Statistics, Nonparametric; Treatment Outcome

Ciclesonide is a novel inhaled corticosteroid that is converted in the lungs to its active metabolite, desisobutyryl-ciclesonide (des-CIC). The aim of this study was to compare the deposition of ciclesonide, as well as its conversion to des-CIC, in the oropharyngeal cavity with fluticasone propionate (FP) following inhalation via hydrofluoroalkane-propelled metered-dose inhalers (HFA-MDIs). Eighteen asthmatics inhaled ciclesonide 800 microg followed by FP 1000 microg or vice versa in an open, randomized, 2-treatment, 2-sequence study design. The oropharynx was washed out immediately and at 15, 30, 45, and 60 minutes after inhalation. Samples were analyzed for ciclesonide, des-CIC, and FP using liquid chromatography with tandem mass-spectrometric detection. Concentration-time curves and area under the concentration-time curve (AUC) were calculated for each drug. Ciclesonide and FP were recovered in almost all samples. Within 60 minutes after inhalation, the amounts of both ciclesonide and FP decreased sharply, and low residual levels were detected after 30 minutes. des-CIC was detected in relatively low concentrations, with maximum concentration 30 minutes following inhalation. The AUC(0-60 min) for ciclesonide (250.4 nmol x h/L) and des-CIC (37.8 nmol x h/L) were found to be significantly lower compared with FP (636.2 nmol.h/L, P < .001). Approximately 50% less ciclesonide and 90% less metabolite were present in the oropharynx compared with FP. Less than 20% of the residual ciclesonide in the oropharynx was metabolized to des-CIC. These findings indicate that oropharyngeal deposition of ciclesonide is only half that of FP following inhalation from an HFA-MDI. Furthermore, there is little activation of ciclesonide to its active metabolite in the oropharynx, suggesting a decreased likelihood of inhaled ciclesonide-associated oropharyngeal side effects.

Topics: Administration, Inhalation; Adult; Androstadienes; Area Under Curve; Asthma; Chromatography, Liquid; Cough; Drug Administration Schedule; Ethanol; Female; Fluticasone; Humans; Male; Mass Spectrometry; Metered Dose Inhalers; Oropharynx; Pregnenediones; Solutions; Therapeutic Irrigation; Time Factors

We aimed to evaluate the efficacy and safety of fluticasone propionate (FP) in children aged 12-47 months with recurrent/persistent asthma symptoms. One hundred and sixty children (12-47 months) were randomised into this multicentre, double-blind, placebo-controlled, parallel-group study, and treated with either FP (100 microg bd) or placebo (2 puffs bd), both administered by metered-dose-inhaler and Babyhaler for 12 weeks. The primary endpoint was percentage of symptom-free 24h periods. Over weeks 1-12, FP-treated patients had significantly more percentage symptom-free 24-h periods compared with placebo (odds ratio 0.53; 95% CI 0.29-0.95; P = 0.035). Relative to baseline, where all patients were symptomatic for at least 21/28 days of the run-in, the improvement equated to one additional symptom-free 24 h period per week. FP patients also had a significantly higher percentage of 24 h periods with no wheeze or cough, the odds ratio for treatment difference corresponding to two additional wheeze-free and one additional cough-free periods per week. FP was well-tolerated, with similar reported adverse events in both groups. Urinary cortisol-creatinine ratio was slightly decreased among FP patients after 12 weeks, but with no clinical correlates. FP is effective for the treatment of chronic persistent asthma symptoms in very young children.

Topics: Administration, Inhalation; Androstadienes; Asthma; Bronchodilator Agents; Child, Preschool; Cough; Double-Blind Method; Female; Fluticasone; Humans; Hydrocortisone; Infant; Male; Odds Ratio; Recurrence; Respiratory Sounds

Chronic cough often lasts for more than 1 year and is associated with airway inflammation. The effect of inhaled corticosteroids on symptom severity and inflammatory mediator levels in these patients is unknown.. We sought to determine whether inhaled corticosteroids reduce cough severity and sputum mediator concentrations in patients with chronic persistent cough.. We performed a double-blind, randomized, placebo-controlled crossover study with inhaled fluticasone, 500 microg twice daily, and placebo for 14 days in 88 patients with cough for more than 1 year, with normal chest radiography and spirometry results. Outcome measures were a daily cough visual analogue scale and induced sputum concentrations of eosinophilic cationic protein (ECP), myeloperoxidase, leukotriene B(4) (LTB(4)), leukotrienes C(4)/D(4)/E(4) (cysteinyl leukotrienes [Cys-LTs]), prostaglandin E(2) (PGE(2)), IL-8, and TNF-alpha. Sputum cell counts, exhaled nitric oxide levels, and carbon monoxide levels were also measured.. There was a significant improvement in the cough visual analogue scale after inhaled fluticasone compared with placebo (mean difference, 1.0; 95% CI, 0.4-1.5; P <.001). LTB(4), Cys-LT, and PGE(2) levels were increased in all causes of cough. Sputum ECP counts, exhaled nitric oxide levels, and carbon monoxide levels decreased significantly after inhaled fluticasone. There was no change in sputum cell counts and other mediator concentrations.. Cough severity and sputum ECP levels are modestly reduced by inhaled corticosteroids in patients with chronic cough persisting for more than 1 year. LTB(4), Cys-LT, PGE(2), IL-8, myeloperoxidase, and TNF-alpha levels are unaltered by this therapy. This raises the possibility that drugs targeted to reduce the effects of these mediators might be of benefit in chronic persistent cough.

Topics: Administration, Inhalation; Adult; Aged; Androstadienes; Chronic Disease; Cough; Cross-Over Studies; Double-Blind Method; Female; Fluticasone; Humans; Inflammation Mediators; Male; Middle Aged; Nitric Oxide; Sputum

To investigate the effect of a short course of inhaled corticosteroid in the treatment of isolated and persistent nocturnal cough in children.. Randomised double blind placebo controlled study.. Subjects' homes in east London, England.. Consecutively referred children, 1-10 years old, with persistent nocturnal cough.. Placebo or fluticasone propionate 1 mg twice daily for three nights and 500 microg twice daily for 11 nights. Videotaping of children at night: two nights' baseline, nights 3 and 4 after three days of inhaled corticosteroid, and nights 15 and 16.. A fall in 75% of coughs from baseline.. 50 subjects were recruited. The median number of coughs in the baseline period for the inhaled corticosteroid group and placebo group were 92 and 71, respectively (p = 0.43) and, on nights 15 and 16, 8 and 36, respectively (p < 0. 01). Compared to baseline, both groups of subjects improved significantly by nights 15 and 16 (p < 0.01; p < 0.01). Comparing the inhaled corticosteroid and placebo groups, coughs fell to a median of 22% and 57% of baseline totals on nights 3 and 4, respectively (p = 0.38), and 8% and 35% on nights 15 and 16, respectively (p = 0.02). 17 of 24 subjects on inhaled corticosteroid who completed the study and 8 of 23 on placebo improved by 75% after two weeks (p = 0.03).. Children with persistent nocturnal cough improve in two weeks after referral on placebo. There is a modest benefit from a two week course of high dose inhaled corticosteroid.

Topics: Administration, Topical; Androstadienes; Anti-Inflammatory Agents; Child; Child, Preschool; Chronic Disease; Circadian Rhythm; Cough; Double-Blind Method; Female; Fluticasone; Follow-Up Studies; Glucocorticoids; Humans; Infant; Male; Patient Compliance; Pilot Projects

To observe the clinical efficacy of self-made Lifei Dingchuan decoction combined with western medicine in the treatment of cough variant asthma (phlegm-heat accumulation in the lung syndrome).. The clinical data of 90 patients with cough variant asthma who were hospitalized in the Department of Respiratory Medicine of our hospital from January 2020 to April 2022 were selected as the research objects, and they were equally divided into the observation group and the reference group according to different treatment methods, 45 cases in each group. The group was treated with traditional montelukast sodium chewable tablet and salmeterol fluticasone mixed powder inhalation, and the observation group was treated with self-made Lifei Dingchuan decoction on the basis of the control group, saturation, pH, partial pressure of oxygen in arterial blood, partial pressure of carbon dioxide, length of stay, and hospitalization costs.. After the patients underwent self-made Lifei Dingchuan decoction, there were significant differences between the observation group and the reference group in terms of heart rate, respiratory rate, blood oxygen saturation, pH value, arterial blood oxygen partial pressure, carbon dioxide partial pressure, and within the group. There was a statistical difference (. The study on the clinical efficacy and low hospitalization cost of the self-prepared lung and asthma-restorative soup in patients with cough variant asthma significantly improved the patients' arterial oxygen saturation, acid-base value, arterial partial pressure of oxygen, and partial pressure of carbon dioxide and effectively controlled the heart rate and respiratory rate with high safety, which is worth further promotion.

Topics: Acetates; Asthma; Carbon Dioxide; Cough; Cyclopropanes; Fluticasone; Humans; Oxygen; Powders; Quinolines; Salmeterol Xinafoate; Sulfides; Tablets

Inhaled corticosteroids (ICS) are a treatment of choice for eosinophilic airway diseases, but their efficacy for other causes of chronic cough is controversial.. We conducted a prospective observational study to determine the ICS efficacy and clinical predictors of response to ICS in patients with upper airway cough syndrome (UACS) or unexplained chronic cough (UCC). Sixty-eight patients with UACS and 33 patients with UCC (duration of cough ≥ 8 weeks) were treated with ICS: 250 µg of fluticasone propionate or 400 µg of budesonide twice a day at physician's discretion. They were followed after 2 weeks to assess persistent cough which was measured as 0% to 100% compared with baseline cough frequency.. The median grade of persistent cough after 2-week ICS treatment was 40% (interquartile range [IQR], 10 to 70) in UACS and was 50% (IQR, 20 to 70) in UCC. The only adverse event was infrequent, mild hoarse voice (five UACS and one UCC). Long duration of cough (≥ 52 weeks) and cough not aggravated by cold air exposure were predictors of a poorer response to short course ICS treatment (logistic regression analysis, p = 0.018 and p = 0.031, respectively). However, prolonged treatment with ICS more than 2 weeks was more effective in patients with long cough duration (≥ 52 weeks).. Short course ICS treatment has modest efficacy on UACS and UCC without significant adverse events. Duration of cough and cough triggered by cold air exposure were the clinical factors associated with ICS response. Extended treatment with ICS may be beneficial in patients with long duration of cough.

Topics: Administration, Inhalation; Adult; Bronchodilator Agents; Budesonide; Chronic Disease; Cough; Female; Fluticasone; Glucocorticoids; Humans; Male; Middle Aged; Republic of Korea; Treatment Outcome

Chronic cough is associated with airway inflammation and remodelling. Abnormal airway smooth muscle cell (ASMC) function may underlie mechanisms of chronic cough. Our objective was to examine the transcriptome and focused secretome of ASMCs from chronic cough patients and healthy non-cough volunteers. ASMC gene expression profiling was performed at baseline and/or after stimulation with polyinosinic:polycytidylic acid (poly(I:C)) to mimic viral infection. Supernatants were collected for multiplex analysis. Our results showed no significant differentially expressed genes (DEGs, false discovery rate (FDR) <0.05) between chronic cough and healthy non-cough ASMCs at baseline. Poly(I:C) stimulation resulted in 212 DEGs (>1.5 fold-change, FDR <0.05) in ASMCs from chronic cough patients compared with 1674 DEGs in healthy non-cough volunteers. The top up-regulated genes included chemokine (C-X-C motif) ligand (CXCL) 11 (

Topics: Airway Remodeling; Anti-Inflammatory Agents; Antigens; Bronchi; Bronchoscopy; Chronic Disease; Cough; Cytokines; Cytoskeletal Proteins; Female; Fluticasone; Gene Expression Profiling; Humans; Immunity, Innate; Inflammation; Male; Middle Aged; Myocytes, Smooth Muscle; Pilot Projects; Poly C

A 56-year-old woman was referred to our hospital because of dyspnea, wheezing, and a productive cough. Eight years before presentation, bronchial asthma was diagnosed and the patient received inhaled corticosteroids plus antiasthmatic agents (a long-acting inhaled beta2-agonist, leukotriene modifiers, and theophylline). Chest radiography showed small diffuse nodular shadows, and a computed tomographic scan showed thickening of the bronchi and bronchioles, with diffuse centrilobular nodules in both lung fields. A blood test and microscopic examination of the bronchoalveolar fluid revealed marked eosinophilia. Transbronchial lung biopsy and transbronchial biopsy showed eosinophilic bronchitis and bronchiolitis. After treatment with oral prednisolone (40 mg daily) and inhaled corticosteroids, the symptoms, blood eosinophilia, and radiographic findings improved. Recently, several similar cases of eosinophilic bronchiolitis have been reported. Studies of further cases and elucidation of the pathophysiology of eosinophilic bronchiolitis are necessary to establish a concept for this disease and to determine whether it should be classified as a subtype of bronchial asthma or as a distinct entity.

Topics: Androstadienes; Asthma; Bronchiolitis; Bronchitis; Bronchoalveolar Lavage Fluid; Bronchoscopy; Cough; Diagnosis, Differential; Dyspnea; Eosinophilia; Female; Fluticasone; Hematologic Tests; Humans; Middle Aged; Prednisolone; Radiography, Thoracic; Respiratory Function Tests; Respiratory Sounds

Increased concentrations of exhaled nitric oxide (ENO) are identified predominantly in subjects with chronic cough due to conditions that habitually respond well to therapy with inhaled corticosteroids (ICSs). The aim of this study was to assess the usefulness of ENO in predicting the response to ICS therapy in subjects with chronic cough and to determine the relationship between either methacholine or adenosine 5'-monophosphate (AMP) responsiveness and the response to ICS therapy.. A total of 43 patients with chronic cough were studied. During the baseline period, ENO measurement, spirometry, and concentration-response studies with both methacholine and AMP were performed. For the next 4 weeks, the patients were treated with inhaled fluticasone propionate, 100 microg twice daily. At baseline (1 week) and during the 4-week treatment period, patients twice daily completed entries in a diary, in which they recorded daytime and nighttime cough symptom scores.. Nineteen patients (44%) responded well to fluticasone therapy. The receiver operating characteristic curve analysis showed that the accuracy of identifying the response to ICS therapy for ENO at baseline was poor. The sensitivity and specificity of ENO for predicting the response to ICS therapy, using 20 parts per billion as the ENO cutoff point, were 53% and 63%, respectively. Differences in both prevalence and degree of airway responsiveness to either methacholine or AMP between fluticasone-responsive subjects and nonresponsive subjects were also not significant.. Although a significant proportion of subjects with chronic cough respond well to ICS therapy, these patients cannot be identified by ENO levels or AMP responsiveness at baseline.

Topics: Adenosine Monophosphate; Administration, Inhalation; Adolescent; Adult; Aged; Androstadienes; Bronchial Provocation Tests; Bronchodilator Agents; Chronic Disease; Cough; Female; Fluticasone; Humans; Male; Methacholine Chloride; Middle Aged; Nitric Oxide; Predictive Value of Tests; Prospective Studies; ROC Curve; Sensitivity and Specificity; Spirometry

The postnasal drip (PND) syndrome is often linked as a cause of chronic cough although this is disputed.. We examined the effect of specific topical treatment of rhinosinusitis on cough in patients presenting with a chronic cough associated with a postnasal drip or 'nasal catarrh'.. Patients presenting with a chronic cough and who complained of PND were enrolled and symptoms of PND and cough were assessed by questionnaire and by a capsaicin cough response. Rhinosinusitis was assessed by questionnaires, direct examination of the nose and by high-resolution computed tomography. In an open study, they were treated with fluticasone nasules, ipratropium bromide and azelastine nasal sprays for 28 days, after which they were re-assessed.. Eighteen out of 21 patients completed the study. All patients reported having the presence of mucus in the throat. Mean cough score improved post-treatment (p<0.05), but there was no significant change in capsaicin cough sensitivity or nasal catarrh questionnaire score. There was improvement in anterior nasal discharge symptom scores (p=0.005) and in endoscopic nasal scores post-treatment (p<0.01), with a tendency to improved PND scores.. In a pilot open 'real-life' study treatment targeted towards rhinosinusitis accompanying PND syndrome and chronic cough led to an improvement in cough. A randomised controlled study is now needed to confirm or refute these findings.

Topics: Administration, Intranasal; Adolescent; Adult; Aged; Androstadienes; Anti-Inflammatory Agents, Non-Steroidal; Chronic Disease; Cough; Female; Fluticasone; Humans; Male; Middle Aged; Nasal Mucosa; Phthalazines; Quality of Life; Rhinitis; Sinusitis; Surveys and Questionnaires; Syndrome; Tomography, X-Ray Computed; Treatment Outcome; Young Adult

An inlet patch of gastric mucosa in the upper esophagus is usually an incidental, congenital finding found during upper gastrointestinal tract endoscopy. Although it has been reported to cause dysphagia, strictures, adenocarcinoma, and webs, it has never been associated with cough and vocal cord dysfunction.. To report the first case of a patient with an inlet patch of gastric mucosa in the upper esophagus as the cause of a particularly troublesome, chronic cough that was initially missed on 2 upper endoscopies.. The patient is a 50-year-old man with a 7-year history of chronic cough associated with hoarseness, shortness of breath, and globus sensation. For diagnostic evaluation, pulmonary function tests, chest computed tomography, rhinolaryngoscopy, upper gastrointestinal tract endoscopy, and histologic examinations were performed.. A multidisciplinary approach revealed several possible causes for the chronic cough, including vocal cord dysfunction, postnasal drip syndrome, allergic rhinitis, and mild gastroesophageal reflux disease that was only partially responsive to therapy. The results of 2 initial upper gastrointestinal tract endoscopies were interpreted as normal. A third endoscopy detected an inlet patch of gastric mucosa in the upper esophagus. Treatment with a high-dose histamine type 2 receptor antagonist and a proton pump inhibitor alleviated the patient's symptoms.. An inlet patch of gastric mucosa in the upper esophagus is not uncommon, but it is often overlooked or believed to be an incidental, congenital finding. This is the first report, to our knowledge, of an inlet patch resulting in a troublesome, chronic cough.

Topics: 2-Pyridinylmethylsulfinylbenzimidazoles; Androstadienes; Anti-Allergic Agents; Cough; Endoscopy, Gastrointestinal; Esophageal Diseases; Fluticasone; Gastric Mucosa; Humans; Lansoprazole; Laryngeal Diseases; Male; Middle Aged; Omeprazole; Proton Pump Inhibitors; Respiratory Function Tests; Vocal Cords

Topics: Androstadienes; Anti-Inflammatory Agents; Bronchitis; Cough; Eosinophilia; Female; Fluticasone; Humans; Male; Prognosis; Treatment Outcome

We studied 223 outpatients who presented between October 2001 and June 2003 with persistent cough of more than 3 weeks' duration. Eosinophilic airway disorders (EAD), including atopic cough and cough variant asthma, were clinically diagnosed in 119 patients, on the basis of the following factors: history of atopic disease, duration of cough, history of previous prolonged cough, or presence of forced expiration wheeze. Since eosinophils are frequently found in the sputum of patients with EAD, a positive test strongly suggests the presence of EAD. In this study, the test was positive in 86% of the patients with EAD. The patients with clinically diagnosed EAD, including those with no eosinophils in the sputum, were treated with inhaled fluticasone 400 or 800 microg/day. Fluticasone was effective in 97% of the patients with EAD and was more effective than bronchodilators or antiallergic drugs. When we compared the results of fluticasone 400 microg/day with those of 800 microg/day doses, the cough disappeared within 1 week in 28% of the patients who received 400 microg/day, whereas in 76% with 800 microg/day. Among the patients with diagnosed EAD, bronchial asthma developed in 6 patients during the observation period. Most of these patients had forced expiration wheeze and lower FEV 1 at the initial visit. This study showed that EAD could be diagnosed in the early stage on the basis of thorough history-taking, the presence of forced expiration wheeze and detection of eosinophils in the sputum. It is important to diagnose and treat EAD as early as possible since inhaled steroid is highly effective.

Topics: Administration, Inhalation; Adult; Androstadienes; Anti-Inflammatory Agents; Asthma; Bronchitis; Cough; Eosinophilia; Female; Fluticasone; Gastroesophageal Reflux; Humans; Male; Retrospective Studies