Atorvastatin, a cholesterol-lowering drug, may be used as a potential anti-inflammatory therapy in bronchiectasis. The study entitled “Atorvastatin as a stable treatment in bronchiectasis: a randomised controlled trial” was published in The Lancet Respiratory Medicine by Pallavi Mandal from MRC Centre for Inflammation Research, Queen’s Medical Research Institute, Edinburgh, UK, and colleagues.
Bronchiectasis is a debilitating disease that affects 1 in 1,000 British adults, and is associated with constant cycles of bacterial infection and inflammation in the lungs and airways. The patients have persistent symptoms that include chronic coughing, excessive phlegm production and consecutive chest infections. Its pathogenesis is not very clear but it has been observed as having high neutrophilic-associated inflammation in airways. Frequently, bronchiectasis etiology is not known but it has been associated with severe lung infections during childhood, such as whooping cough or pneumonia, which damage the airways.
Studies have suggested a pleiotropic effect of statins in patients with bronchiectasis. Statins are frequently given to individuals at risk of heart attack since they can reduce cholesterol levels. However, experimental evidence also reveals that statins have anti-inflammatory effects.
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The research team decided to assess if atorvastatin could reduce cough in patients with bronchiectasis by conducting a randomized controlled trial (ClinicalTrials.gov, number NCT01299181). They recruited patients between 18 and 79 years of age from a secondary-care clinic in Edinburgh, UK. The patients had bronchiectasis (cough and sputum production when clinically stable) and two or more chest infections in the previous year. The participants were randomly distributed to be treated either with high-dose atorvastatin (80 mg) or a placebo, given orally every day for 6 months. The primary endpoint was reduction in cough during treatment, measured by the Leicester Cough Questionnaire (LCQ) score, with a lower score meaning a more severe cough.
The researchers found that a daily high dose of statins for six months significantly improved coughing symptoms for 12 out of the 30 patients treated in the study. After six months of statin treatment, patients could better perform moderate exercise and walk more than before treatment. They also had fewer exacerbations of disease and inflammation in their airways.
This study suggested that statins may be a possible alternative to long-term antibiotic therapy that increases a patient’s probability of infection by antibiotic resistant strains of bacteria like MRSA or C. difficile.
Dr Pallavi Mandal said in a news release, “There are few effective treatments for bronchiectasis so these are encouraging findings. Larger studies are now needed to find out whether statins could be useful as a long-term treatment option for patients with this disease.”