Inhaler for cough
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Inhalers for Cough: A Comprehensive Overview
Lidocaine Inhalation for Cough Suppression
Lidocaine, a local anesthetic, has shown promise in suppressing severe, intractable coughs. In a study, nebulized lidocaine, administered after standard nebulized albuterol, was effective in reducing cough severity in patients with asthma, reactive airways disease, and chronic obstructive pulmonary disease (COPD). This treatment provided significant relief, especially in improving sleep and daily activities, suggesting its potential as a temporary measure while waiting for more definitive therapies to take effect1.
Sodium Cromoglicate (PA101) for Chronic Cough in IPF
A novel formulation of sodium cromoglicate, known as PA101, has been tested for its efficacy in treating chronic cough associated with idiopathic pulmonary fibrosis (IPF). Delivered via a high-efficiency eFlow nebulizer, PA101 significantly reduced daytime cough frequency by 31.1% in patients with IPF over a two-week period. However, it did not show the same effectiveness in patients with chronic idiopathic cough (CIC). The study highlights the potential of PA101 as a treatment option for chronic cough in IPF, warranting further investigation2.
Bronchodilators for Cough-Variant Asthma
Bronchodilators, such as metaproterenol sulfate, have been evaluated for their effectiveness in treating cough-variant asthma. In a study, patients with chronic cough and positive methacholine inhalation challenge (MIC) results showed significant improvement in cough severity after one week of inhaled beta-agonist therapy compared to placebo. This indicates that bronchodilators can be effective in diagnosing and treating cough-variant asthma when followed by a favorable response to therapy3.
Adverse Effects of Inhalation Products
Cough can be an adverse effect of inhalation pharmaceutical products, influenced by various factors such as the type of inhaler device, drug formulation, and excipients. Mechanical or chemical stimulants in the inhalers can activate cough receptors, especially in diseased airways where bronchoconstriction is present. Understanding these factors is crucial for designing inhalation products that minimize cough as a side effect4 9.
Menthol Inhalation for Chronic Cough
Menthol, known for its cooling properties, has been studied for its effect on chronic cough. Inhalation of nebulized menthol significantly increased cough thresholds and reduced cough sensitivity to capsaicin in patients with chronic cough. This suggests that menthol could be a useful agent in managing chronic cough by reducing cough reflex sensitivity6.
Bronchodilators and Cough Response
Bronchodilators such as salbutamol and ipratropium have been shown to reduce cough response in both normal and asthmatic subjects. In asthmatic patients, these bronchodilators significantly diminished the cough response to citric acid aerosols, indicating their potential in managing cough associated with asthma. The reduction in cough response is likely related to changes in bronchial calibre and neuroreceptor sensitivity5 7.
High-Dose Inhaled Beclomethasone for Chronic Cough
Inhaled corticosteroids like beclomethasone have been tested for their effectiveness in treating chronic cough. A study found that high-dose beclomethasone significantly resolved cough in 82% of patients over a two-week period, compared to 15% in the placebo group. This suggests that inhaled corticosteroids can be highly effective in managing chronic cough, particularly in patients without postnasal drip or gastroesophageal reflux disease8.
Terbutaline for Fentanyl-Induced Cough
Terbutaline, a selective beta 2-adrenergic bronchodilator, has been found to suppress fentanyl-induced cough effectively. In a study, inhalation of terbutaline significantly reduced the incidence of cough compared to placebo, highlighting its potential use in preventing cough induced by certain medications10.
Conclusion
Inhalers play a crucial role in managing various types of cough, from chronic conditions like IPF and asthma to medication-induced cough. Lidocaine, sodium cromoglicate, bronchodilators, menthol, and corticosteroids have all shown varying degrees of effectiveness in different contexts. Understanding the specific mechanisms and appropriate applications of these inhalers can significantly improve patient outcomes and quality of life. Further research is warranted to optimize these treatments and explore new therapeutic options.
Sources and full results
Most relevant research papers on this topic
Lidocaine inhalation for cough suppression.
Nebulized lidocaine effectively suppresses cough in selected patients with intractable cough, potentially buying time for more definitive therapies.
Non-RCTA novel formulation of inhaled sodium cromoglicate (PA101) in idiopathic pulmonary fibrosis and chronic cough: a randomised, double-blind, proof-of-concept, phase 2 trial.
Inhaled PA101 significantly reduced daytime cough frequency in patients with idiopathic pulmonary fibrosis compared to placebo, but showed no treatment benefit for chronic idiopathic cough.
RCT
Rigorous Journal
Highly CitedInterpretation of positive results of a methacholine inhalation challenge and 1 week of inhaled bronchodilator use in diagnosing and treating cough-variant asthma.
Positive methacholine inhalation challenge results are only diagnostic of asthma when followed by a favorable response to asthma therapy, and only cough-variant asthma significantly improves after 1 week of inhaled beta-agonist use.
RCTHighly CitedCough as an adverse effect on inhalation pharmaceutical products
Inhalation pharmaceutical products may cause cough due to factors such as inhaler device, drug, dose, excipients, and formulation characteristics, which may stimulate cough receptors and reduce drug delivery to the lungs.
Very Rigorous JournalInhibition of artificially induced cough in man by bronchodilators.
Inhaled fenoterol hydrobromide and ipratropium bromide significantly reduce artificially induced cough in normal subjects, with small reductions in airway tone correlated with reduced cough response.
RCTInhalation of menthol reduces capsaicin cough sensitivity and influences inspiratory flows in chronic cough.
Pre-inhalation of menthol reduces cough sensitivity to capsaicin and influences inspiratory flows in patients with chronic cough.
RCTEffect of bronchodilators on the cough response to inhaled citric acid in normal and asthmatic subjects.
Bronchodilators can reduce asthmatic patients' cough response to inhaled citric acid, potentially due to altered neuroreceptor sensitivity and rapid changes in bronchial calibre.
RCTHighly CitedHigh-dose inhaled beclomethasone treatment in patients with chronic cough: a randomized placebo-controlled study.
High-dose inhaled beclomethasone effectively reduced chronic cough symptoms in a subgroup of patients without correlation to atopy or airway hyperresponsiveness.
RCTPost-inhalation cough with therapeutic aerosols: Formulation considerations.
Post-inhalation cough with therapeutic aerosols can be limited by using insoluble neutral forms of drugs and excipients, reducing changes in epithelial lining fluid composition.
Terbutaline inhalation suppresses fentanyl-induced coughing.
Inhalation of terbutaline effectively inhibits fentanyl-induced cough, while atropine shows no efficacy, suggesting bronchoconstriction may be the mechanism.
RCT