Effect of a thromboxane synthetase inhibitor, ozagrel hydrochloride, on peak expiratory flow in stable asthmatics treated with beclomethasone diproprionate

Steroid inhalation therapy is recommended for treatment of moderate to severe asthma, but it is unknown whether the therapy sufficiently suppresses production of thromboxane A2 (TXA2), one of the inflammatory lipid mediators. The effect of a selective orally active thromboxane synthesis inhibitor, ozagrel hydrochloride (200 mg twice a day for 4 weeks), on morning and evening peak expiratory flow (PEF) was examined in 70 stable asthmatics receiving beclomethasone diproprionate (BDP) inhalation therapy (800 μg/day) by a randomized, placebo-controlled, single-blinded study. Morning PEF was significantly increased from 313.5 ±13.1 (mean ± SEM) L/min to 325.7 ± 12.2 L/min at 1 week, 335.5 ± 12.7 L/min at 2 weeks, 338.6 ±13.4 L/min at 3 weeks, and 340.0 ± 13.2 L/min at 4 weeks in 35 patients treated with ozagrel but not in the other 35 patients treated with a placebo. The percent increase in the morning PEF was significantly greater with ozagrel than with the placebo. It is speculated that inhibition of thromboxane synthesis by medium dose of steroid inhalation therapy may be insufficient in some asthmatics

Eosinophilic pneumonia (EP) associated with rheumatoid arthritis in which drug-induced eosinophilic pneumonia could be ruled out

金沢大学附属病院呼吸器内科A 72 year-old man. He was diagnosed with rheumatoid arthritis in 2002. In January 2005 he noted productive cough and fever; he was diagnosed as eosinophilic pneumonia (EP). We discontinued administration of bucillamine and methotrexate and started to treat with oral prednisolone 30 mg daily. To rule out drug-induced EP, prednisolone was tapered by 10 mg per week. Consolidation occurred in the right lower lobe when prednisolone was decreased to 5 mg daily. After increasing the dose of prednisolone to 30 mg daily again, consolidation was promptly resolved. It was considered to be important to rule out drug-induced EP. © 2008 The Japanese Society of Internal Medicine

Antitussive Effects of the Leukotriene Receptor Antagonist Montelukast in Patients with Cough Variant Asthma and Atopic Cough

ABSTRACTBackgroundChronic cough is the only symptom of cough variant asthma (CVA) and atopic cough (AC). Cysteinyl leukotriene receptor antagonists have been shown to be effective in CVA, but there are no reports on their effectiveness in AC. To evaluate the antitussive effect of montelukast, a leukotriene receptor antagonist, in CVA and AC.MethodsSeventy-five patients with chronic cough received diagnostic bronchodilator therapy with oral clenbuterol hydrochloride for 6 days. Of the 75 patients, 48 and 27 met the simplified diagnostic criteria for CVA and AC, respectively. Patients with CVA were randomly divided into 3 groups: montelukast, clenbuterol, and montelukast plus clenbuterol. Patients with AC were randomly divided into 2 groups: montelukast and placebo. The efficacy of cough treatment was assessed with a subjective cough symptom scale (0 meant “no cough” and 10 denoted “cough as bad as at first visit”). The cough scale, pulmonary function test, and peak expiratory flow rate (PEF) were evaluated before and after 2 weeks of treatment.ResultsIn patients with CVA, 2-week treatment with montelukast, clenbuterol, and montelukast plus clenbuterol all significantly decreased cough scores and treatment with montelukast plus clenbuterol was superior to treatment with montelukast alone. In the montelukast plus clenbuterol group, PEF values in the morning and evening significantly increased after 2 weeks compared with values before treatment. In patients with AC, scores on the cough scale did not differ significantly between the montelukast group and the placebo group.ConclusionsMontelukast was confirmed to suppress chronic non-productive cough in CVA, whereas it was not effective in non-productive cough in AC