ABSTRACT
BACKGROUND: Budesonide at 800 µg/d is generally suggested for treatment of nonasthmatic eosinophilic bronchitis (NAEB). In asthma, adjunctive therapy with montelukast has been shown to confer addictive anti-inflammatory effects to inhaled corticosteroid (ICS). However, whether such effects could be extrapolated to NAEB is not known. OBJECTIVES: To study the efficacy and tolerability of add-on therapy with montelukast as compared to double-dose ICS in suppressing airway eosinophilia and decreasing cough severity in NAEB. METHODS: In a randomized controlled trial, 26 nonsmoking, steroid-naïve NAEB patients presenting with chronic cough were treated with 800 µg/d budesonide or 400 µg/d budesonide plus montelukast 10 mg/d for 4 weeks. Cough visual analogue scale (CVAS) and eosinophil differential ratio in induced sputum (Eos) were monitored at baseline, Week 1, 2 and 4. Adverse events during treatment were recorded. RESULTS: The two groups were comparable in age, gender distribution, cough duration, FEV(1)% predicted, FEV(1)/FEV ratio, baseline CVAS and geometric mean of Eos. Both regimens significantly reduced Eos and CVAS throughout the treatment course, with abrogation of sputum eosinophilia at end of therapy. There was no significant difference between the two groups in reduction of Eos and CVAS at all time points. Both regimens were well tolerated. CONCLUSIONS: This preliminary study demonstrated that add-on montelukast might be an effective and well tolerated alternative to the generally suggested dose of ICS in treating steroid-naive NAEB, with suppression of eosinophilic inflammation, reduction of cough severity and sparing of ICS doses. (NCT01121016).
Subject(s)
Acetates/administration & dosage , Bronchitis/drug therapy , Bronchodilator Agents/administration & dosage , Budesonide/administration & dosage , Leukotriene Antagonists/administration & dosage , Pulmonary Eosinophilia/drug therapy , Quinolines/administration & dosage , Adult , Aged , Bronchitis/physiopathology , Chronic Disease , Cough/drug therapy , Cyclopropanes , Drug Therapy, Combination , Female , Forced Expiratory Volume/physiology , Humans , Male , Middle Aged , Pilot Projects , Pulmonary Eosinophilia/physiopathology , Sulfides , Treatment Outcome , Young AdultABSTRACT
Primary tracheal non-Hodgkin lymphoma is an extremely rare entity without consensus management strategy. We present a case of primary tracheal lymphoplasmacytoid lymphoma masquerading as asthma with wheezing and progressive dyspnea. A patented nitinol mesh stent was implanted in the right lateral cervical region 3 weeks before tumor resection. After 5.5-cm-long segmental tracheal resection, a neotracheal tube was constructed with cervical myocutaneous flap sandwiched around the implanted mesh stent, which was then anastomosed with the residual of the patient's trachea. The patient has been well for 30 months.