Effect of salbutamol on smoking related cough
Introduction
Chronic cigarette smoking leads to a dose related cough and smokers cough is typically productive [1], [2], [3]. Smoking is associated with airway inflammation manifested as an increase in macrophages and cells expressing interleukin and adhesion molecule receptors. The consequence of this inflammation is an increase in non-specific bronchial hyperresponsiveness, even in subjects with normal lung function [2]. This airway inflammation mimics many of the pathological features seen in disease states characterised by chronic cough. We hypothesised that smoking related cough could provide a useful model to test anti-tussive activity which would be of relevance in clinical practice.
β Agonists have a marked bronchoprotective effect on non-specific bronchial hyperresponsiveness but have little or no effect on the cough reflex in healthy individuals. Salbutamol has no effect on induced cough in normal subjects, but does alter cough response in asthmatics [4]. If smokers' cough does mirror disease related alterations in the cough reflex then salbutamol should have detectable activity in this model. We therefore performed a study to determine the anti-tussive effects of salbutamol in smoking related cough.
Section snippets
Methods
A two way cross over study was performed to determine the efficacy of salbutamol via inhaler versus placebo on natural (i.e. on waking, before contact with triggers) and evoked (following the first cigarette) cough in habituated smokers.
The primary efficacy endpoint was a reduction in cough frequency after waking on treatment day 1 over the following periods: 0–10, 10–20, 20–40, and 40–60 min. The secondary efficacy endpoints were a reduction in cough frequency on treatment days 2–5, nocturnal
Results
Males (31) and females (13) of age range 20–61 years were recruited. Mean FEV1 was 4.1 l (range 2.8–6) and mean pack years 20.4 (range 5–100). At screening mean salbutamol reversibility was 5% and mean PD10 was 0.67 mg.
Total cough frequency was reduced from 6 to 4.5 in the first 20 min after salbutamol inhalation (p<0.05, CI of difference 0.02 and 2.9). There was no statistically significant reduction in total cough frequency at the other time intervals. (Fig. 1 and Table 1, Table 2). On the
Discussion
Cough is a troublesome symptom in smokers and in those attempting smoking cessation. The cough associated with smoking is multifactorial, related to bronchoconstriction, alteration in cough threshold [8], airway inflammation [9], [10], and the fact that smoke is an irritant fume. Salbutamol appears to have anti-tussive properties in asthma due to bronchodilation and reduced bronchial hyperresponsiveness. We hypothesised that it may have a role in the treatment of smoking related cough as short
Acknowledgements
Funded by an unrestricted grant from GlaxoSmithKline.
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