title: Superiority of nebulized corticosteroids over dry powder inhalers in certain patients with cough variant asthma or cough-predominant asthma.
abstract: BACKGROUND
  The particle distribution might differ between nebulizer therapy and metered-dose inhaler (MDI) or dry powder inhaler (DPI) therapy because the particles repeatedly enter/re-enter the airways with the nebulizer. Inhaled corticosteroids (ICS) were administered with a nebulizer to assess the benefit of changes in the distribution of particles in patients with cough variant asthma (CVA) and cough-predominant asthma (CPA).
  
  
  METHODS
  Patients whose symptoms were not controlled by their current therapy were enrolled. In patients receiving high-dose ICS by MDI or DPI (ICS-MDI/DPI), steroid therapy was switched to 1,320μg/day of nebulized dexamethasone (1,600μg as dexamethasone sodium phosphate) (chronic steroid-independent group). In patients receiving systemic steroids regardless of their ICS-MDI/DPI therapy, nebulized dexamethasone was added and any concurrent ICS-MDI/DPI therapy was halted to detect a steroid-sparing effect (chronic steroid-dependent group). In patients with acute exacerbation of CVA or CPA and persistent symptoms despite systemic corticosteroids, nebulized dexamethasone was added to assess its effect (acute group).
  
  
  RESULTS
  Superior symptom control was achieved in 10 out of 12 steroid-independent patients, 3 out of 6 steroid-dependent patients, and all 7 acute patients.
  
  
  CONCLUSIONS
  Delivery of ICS via a nebulizer has advantages over ICS-MDI/DPI in some patients with CVA or CPA.
authors.affiliation: Department of Pulmonology, National Hospital Organization Disaster Medical Center, 3256Midori-machi, Tachikawa-shi, Tokyo, Japan. kamimura@tdmc.hosp.go.jp
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Kamimura
authors.forename: Shinyu
authors.initials: S
authors.lastname: Izumi
authors.forename: Yoichiro
authors.initials: Y
authors.lastname: Hamamoto
authors.forename: Akane
authors.initials: A
authors.lastname: Morita
authors.forename: Emiko
authors.initials: E
authors.lastname: Toyota
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Kobayashi
authors.forename: Koichiro
authors.initials: K
authors.lastname: Kudo
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage* / Q000009:adverse effects; D000328:Adult; D000368:Aged; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001249:Asthma / Q000150:complications / Q000188:drug therapy*; D003371:Cough / Q000150:complications / Q000188:drug therapy*; D058995:Dry Powder Inhalers; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009330:Nebulizers and Vaporizers; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones; D018927:Anti-Asthmatic Agents