Inhaled steroids in patients with bronchiectasis

Elborn, J.S.; Johnston, Brian T.; Allen, F.; Clarke, J.; McGarry, John; Varghese, George

doi:10.1016/s0954-6111(06)80227-1

Cited by 94 publications

(66 citation statements)

References 12 publications

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“…ELBORN et al [35] reported that inhaled corticosteroids were of symptomatic benefit in bronchiectasis. They also noted an increase in PC20 histamine by at least one doubling dose in subjects with AHR.…”

Section: Discussionmentioning

confidence: 99%

Effect of roxithromycin on airway responsiveness in children with bronchiectasis: a double-blind, placebo-controlled study

Koh¹,

Lee²,

Sun³

et al. 1997

Eur Respir J

132

103

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Increased airway responsiveness (AR) is frequently associated with bronchiectasis. Roxithromycin is a new semisynthetic macrolide antibiotic that also has anti-inflammatory activities. This study was designed to see whether roxithromycin could favourably alter the degree of AR in patients with bronchiectasis and increased AR. Twenty five children with bronchiectasis, who had an increased AR (defined as a provocative concentration of methacholine causing a 20% fall in forced expiratory volume in one second (FEV1) (PC20) <25 mg x mL(-1) evaluated by the dosimeter method), were randomized, double-blind into two parallel groups. Thirteen of the children were treated with roxithromycin (4 mg x kg(-1) b.i.d.) for 12 weeks and 12 received placebo. FEV1, sputum purulence and leucocyte scores were assessed every 3 weeks. To estimate AR, high-dose methacholine challenge tests were performed before and after treatment. On the dose-response curve to methacholine, PD20 and maximal response (two indices of AR) were measured. Changes in FEV1 were not observed during the course of the study in both groups. A significant improvement in sputum features was noted after 6 weeks of treatment in the roxithromycin group. After 12 weeks of roxithromycin therapy, the geometric mean (range of 1 SD) of provocative cumulative dose producing a 20% fall in FEV1 (PD20) increased significantly (p<0.01) to 169.2 (83.2-344.2) breath units (BU) (1 BU denotes one inhalation of 1 mg x mL(-1) methacholine) and the mean+/-SD of maximal response decreased significantly (p<0.01) to 32.5+/-6.8%, as compared with the initial values (PD20 87.1 (47.3-160.4) BU; maximal response 40.9+/-7.4%). No significant changes in either parameter were observed in the placebo group. Our results indicate that roxithromycin may decrease the degree of airway responsiveness in patients with bronchiectasis and increased airway responsiveness. Further study is necessary to determine the mechanism by which roxithromycin reduces airway responsiveness in bronchiectasis and its clinical impact.

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Section: Discussionmentioning

confidence: 99%

Effect of roxithromycin on airway responsiveness in children with bronchiectasis: a double-blind, placebo-controlled study

Koh¹,

Lee²,

Sun³

et al. 1997

Eur Respir J

132

103

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“…44 To date, randomised controlled studies have shown regular high-dose inhaled corticosteroids (fluticasone 500 µg twice daily, or beclomethasone 750 µg twice daily) reduce 24-hour sputum volume and improve health-related quality of life, but have no impact on FEV1 or exacerbation frequency. [45][46][47] The optimal dose requires further clarification and at present the current evidence is insufficient to support the routine prescription of inhaled corticosteroids in bronchiectasis, but a sixmonth trial may be warranted for patients with severe disease or evidence of airways obstruction.…”

Section: Inhaled Corticosteroidsmentioning

confidence: 99%

CME: Non-cystic fibrosis bronchiectasis

2011

J R Coll Physicians Edinb

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Bronchiectasis is a chronic debilitating condition. Pathologically, a vicious cycle of infection and inflammation exists in the permanently damaged airways with patients suffering a persistent cough, chronic daily sputum production and recurrent chest infections. Once termed an 'orphan disease', the prevalence of bronchiectasis has become increasingly recognised over the past few decades. The associated burden of disease in terms of respiratory morbidity, effect on patients' healthrelated quality of life and the economic cost of long term management is significant and it has become apparent that more research into its causes and management is urgently needed. This article reviews what is currently known about bronchiectasis, its pathophysiology, aetiology and management strategies.

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“…[19][20][21] These studies used high-dose inhaled corticosteroids (fluticasone 500 µg bd or beclometasone 750 µg bd) but the optimal dose needs further clarification. A six-month trial of inhaled corticosteroids may be warranted, particularly for patients with evidence of airway obstruction and reversibility or with severe bronchiectasis.…”

Section: Inhaled Corticosteroidsmentioning

confidence: 99%