A study on effects of inhaled fluticasone propionate-salmeterol on pulmonary function in non-cystic fibrosis bronchiectasis patients

Abstract

Background: Non-cystic fibrosis (CF) bronchiectasis is a chronic respiratory disease characterized by permanent dilatation of the airways. The patients usually suffer from chronic daily phlegm and breathlessness. Recurrent infections and exacerbations result in the decline of lung function and quality of life. Chronic airway inflammation and bronchoconstriction may contribute to pathophysiology and progression of disease. Inhaled corticosteroid–long-acting β₂-agonist (ICS–LABA) combinations, such as fluticasone propionate–salmeterol, may offer therapeutic benefits. However, evidence in non-cystic fibrosis bronchiectasis remains limited. Methods: A quasi-experimental study was conducted involving 36 non-CF bronchiectasis patients diagnosed by computed tomography scan of thorax. All patients receiving inhaled fluticasone propionate–salmeterol (500/50 µg daily) for 6 months. Primary end point was the change in the prebronchodilator forced expiratory volume in 1 second (FEV1). Secondary end points were change in Transition Dyspnea Index (TDI), rate of exacerbations, and fractional exhaled nitric oxide (FeNO) from baseline. Comparison of these outcomes between patients who had a blood eosinophil count at least 300 per microliter (high) and less than 300 per microliter (low) were also analyzed. Results: The prebronchodilator FEV1 increased from baseline at week 24 by 26 ml (95% CI, -8 to 60). TDI scores increased from baseline to week 24 by 0.417 with statistical significance (95% CI, 0.110 to 0.723), reflecting improvement of dyspnea. Fractional exhaled nitric oxide (FeNO) decreased from baseline to week 24 by -2.500 (95% CI, -6.998 to 2.998). Rate of exacerbations decrease from baseline to week 24 by -0.083 (95% CI, -0.379 to 0.212). Comparison between high and low eosinophil group, no statistically significant change in FEV1, TDI, rate of exacerbations, and FeNO from baseline to week 24 was observed. The most common adverse events were hoarseness of voice and pharyngeal irritation that usually mild and self-resolved except for 2 cases of hoarseness led to treatment discontinuation. Conclusion: Inhaled fluticasone propionate–salmeterol (500/50mcg daily) didn’t improve FEV1 in Non-Cystic Fibrosis bronchiectasis patients. Moreover, higher incidence of dysphonia was observed.