fluticasone-propionate--salmeterol-xinafoate-drug-combination and Cough

Cough variant asthma (CVA) is an important cause of chronic cough, and pathophysiological features of the disease appear to be similar to typical asthma. Because CVA is recognized as a precursor of asthma, early intervention with long-term anti-inflammatory agents may be recommended. However, the role of combination therapy with inhaled corticosteroid and β2-agonist in the treatment of CVA has not been elucidated. To evaluate the effectiveness of the combination therapy, we investigated the clinical impact of regular treatment with salmeterol/fliticasone propionate combination (SFC) and inhaled salmeterol (SAL) alone in patients with CVA.. The study was a randomized, controlled, parallel-group multi-center trial. Forty-three CVA patients were assigned to SFC (50/100 µg once daily) or SAL (50 µg twice daily) for 12 weeks. Then, these medications were stopped for the next 24 weeks. Main outcome measures were cough symptoms, pulmonary function and airway inflammation.. Treatment with each of SFC and SAL significantly decreased cough scores and increased FEV1 and PEF, where the efficacy was more pronounced with SFC than SAL. SFC also decreased sputum eosinophil counts and eosinophil cationic protein contents, whereas SAL had no effect. After discontinuation of the treatment, cough scores increased, pulmonary function and eosinophilic airway inflammation were aggravated and returned to the baseline levels.. Maintenance therapy with SFC provides further improvements in cough symptoms, pulmonary function and airway inflammation, and discontinuation of the therapy causes worsening of the disease, indicating that stopping or interrupting anti-inflammatory therapy may not be advisable in patients with CVA.

Topics: Administration, Inhalation; Adrenal Cortex Hormones; Adult; Albuterol; Androstadienes; Asthma; Bronchodilator Agents; Cough; Drug Combinations; Eosinophils; Female; Fluticasone-Salmeterol Drug Combination; Humans; Inflammation; Male; Middle Aged; Peak Expiratory Flow Rate; Respiratory Function Tests; Salmeterol Xinafoate

Patients undergoing pulmonary resection often suffer from a dry, hacking cough, which is usually refractory to opioid cough suppressors such as codeine. The cough is often painful and impairs the quality of life of the patients. The efficacy of an inhaled corticosteroid plus β2-agonist against the persistent cough after pulmonary resection was evaluated in this study.. We enrolled 21 patients in this prospective study of the efficacy of an inhaled corticosteroid plus β2-agonist against persistent cough following pulmonary resection. After baseline evaluation of the severity of the postoperative persistent cough using a visual analog scale (VAS), treatment with an inhaled corticosteroid plus β2-agonist was initiated and continued for 2 weeks. At the end of the 2 weeks, the cough severity was evaluated again using a VAS.. The median grade of cough on the VAS before the start of the inhaled treatment was 4 (range 3-8). At the end of 2 weeks of treatment with an inhaled corticosteroid plus β2 agonist, the median grade of cough on the VAS decreased from 4 to 1 (range 0-4). As an adverse effect of the inhalation, hoarseness was observed in one patient, which disappeared promptly after discontinuing the inhalations.. Treatment with an inhaled corticosteroid plus β2 agonist appeared to be highly effective, without severe adverse effects, against the persistent cough suffered by patients after pulmonary resection.

Topics: Administration, Inhalation; Adrenal Cortex Hormones; Adrenergic beta-2 Receptor Agonists; Aged; Albuterol; Androstadienes; Antitussive Agents; Budesonide; Budesonide, Formoterol Fumarate Drug Combination; Chi-Square Distribution; Cough; Drug Combinations; Ethanolamines; Female; Fluticasone-Salmeterol Drug Combination; Formoterol Fumarate; Humans; Japan; Male; Middle Aged; Pneumonectomy; Prospective Studies; Severity of Illness Index; Time Factors; Treatment Outcome