Atorvastatin and cough
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Atorvastatin and Cough: Insights from Recent Research
Introduction to Atorvastatin and Bronchiectasis
Bronchiectasis is a chronic respiratory condition characterized by persistent cough, sputum production, and recurrent chest infections. The pathogenesis involves excessive neutrophilic airway inflammation, which contributes to the chronic symptoms experienced by patients. Atorvastatin, a commonly used statin, has been investigated for its potential anti-inflammatory effects in bronchiectasis, particularly its ability to reduce cough and improve quality of life.
Atorvastatin's Impact on Cough in Bronchiectasis Patients
Randomized Controlled Trials (RCTs) on Atorvastatin and Cough
Several randomized controlled trials have explored the efficacy of atorvastatin in reducing cough among bronchiectasis patients. A notable study conducted in Edinburgh involved 60 patients who were randomly assigned to receive either high-dose atorvastatin (80 mg) or a placebo for six months. The primary endpoint was the reduction in cough, measured by the Leicester Cough Questionnaire (LCQ) score. The results showed a significant improvement in the atorvastatin group, with a mean LCQ score change of 1.5 units compared to -0.7 units in the placebo group (mean difference 2.2, p=0.01) 134.
Atorvastatin and Chronic Pseudomonas Aeruginosa Infection
Another study focused on patients with bronchiectasis chronically infected with Pseudomonas aeruginosa. This double-blind crossover RCT involved 32 patients who received either atorvastatin or a placebo for three months, followed by a washout period and crossover. Although atorvastatin did not significantly improve cough (mean difference 1.92, p=0.12), it did result in improved quality of life and reduced systemic inflammation markers such as CXCL8, TNF, and ICAM-1 26.
Mechanisms of Atorvastatin's Effects
Anti-Inflammatory Properties
The anti-inflammatory properties of atorvastatin are believed to play a crucial role in its effects on bronchiectasis. Studies have shown that atorvastatin can reduce serum levels of inflammatory markers and enhance the apoptosis of neutrophils, which may contribute to the reduction in airway inflammation and subsequent improvement in cough 236.
Quality of Life Improvements
In addition to reducing inflammation, atorvastatin has been associated with significant improvements in quality of life for bronchiectasis patients. This is evidenced by better scores on the St. George's Respiratory Questionnaire and the LCQ, indicating that patients experienced fewer symptoms and better overall well-being during atorvastatin treatment 246.
Conclusion
Atorvastatin shows promise as a treatment for reducing cough and improving quality of life in patients with bronchiectasis. While its impact on cough may vary depending on the presence of chronic infections like Pseudomonas aeruginosa, its anti-inflammatory properties and ability to enhance neutrophil apoptosis suggest a beneficial role in managing bronchiectasis. Further multicenter studies are needed to confirm these findings and explore the long-term benefits of statin therapy in this patient population.
Sources and full results
Most relevant research papers on this topic
Atorvastatin as a stable treatment in bronchiectasis: a randomised controlled trial.
Atorvastatin treatment for 6 months improved cough quality-of-life in patients with bronchiectasis, but long-term studies are needed to determine if it reduces exacerbations.
RCT
Rigorous Journal
Highly CitedA Randomized Controlled Trial of Atorvastatin in Patients With Bronchiectasis Infected With Pseudomonas Aeruginosa: A Proof of Concept Study
Atorvastatin reduces systemic inflammation and improves quality of life in patients with bronchiectasis infected with Pseudomonas aeruginosa, potentially due to its ability to modulate neutrophil activation.
RCTRole of statins in controlling cough and improving lung function and exercise capacity in bronchiectasis patients.
High dose atorvastatin can effectively control cough in patients with bronchiectasis, but its role in improving lung function and exercise capacity requires further research.
RCTAtorvastatin as an anti inflammatory in bronchiectasis
Atorvastatin treatment significantly reduced cough symptoms and exacerbations in patients with bronchiectasis, but larger studies are needed.
RCTAtorvastatin as novel treatment in bronchiectasis patients colonized withpseudomonas aeruginosa
Atorvastatin reduced serum inflammation and improved quality of life in bronchiectasis patients chronically infected with Pseudomonas aeruginosa, but did not improve cough.
RCTSafety of atorvastatin derived from analysis of 44 completed trials in 9,416 patients.
Atorvastatin is safe in the 10- to 80-mg dose range, with treatment-associated adverse events similar to those observed with placebo and other statins, and rare serious events rarely leading to treatment discontinuation.
Meta-AnalysisHighly CitedAtorvastatin: safety and tolerability
Atorvastatin is generally well tolerated across its therapeutic dosage range, with rare adverse events (liver function abnormalities and muscle-related side effects) occurring in specific populations.
Systematic ReviewMultiple‐dose pharmacokinetics, pharmacodynamics, and safety of atorvastatin, an inhibitor of HMG‐CoA reductase, in healthy subjects
Atorvastatin doses of up to 80 mg/day were well tolerated and had significant cholesterol-lowering effects in healthy subjects.
RCTHighly CitedAtorvastatin is unlikely to prevent rheumatoid arthritis in high risk individuals: results from the prematurely stopped STAtins to Prevent Rheumatoid Arthritis (STAPRA) trial
Atorvastatin does not show a protective effect on arthritis development in high-risk individuals, mainly due to unwillingness to participate in prevention trials.
RCT