ICS-LABA Proved Effective in Treating Sjogren Syndrome With Bronchiolitis

Patients with bronchiolitis in primary Sjogren’s Syndrome treated with inhaled corticosteroids and long-acting beta agonists (ICS-LABA) showed improvements in lung function and cough symptoms, thus reducing their need for systemic oral corticosteroids, according to research being presented at the American College of Chest Physicians (CHEST) 2022 Annual Meeting , held October 16 to 19, in Nashville, Tennessee.

Systemic oral corticosteroids, the foundation of treatment in bronchiolitis, are often associated with numerous debilitating side effects. Researchers sought to evaluate the use of ICS-LABA in therapy for bronchiolitis in primary Sjogren’s Syndrome.

The investigators conducted a prospective study that included 32 patients (97% female; mean age, 49 years) diagnosed with symptomatic bronchiolitis by lung biopsy or high-resolution computed tomography showing bronchial thickening, pulmonary cysts, mosaic perfusion, and airway trapping. The patients studied had chronic (31%), lymphocytic (31%), obliterans (25%), and follicular (12.5%) bronchiolitis. All patients received low-dose inhaled budesonide-formoterol (ICS-LABA) 80/5 µg twice daily for 12 months. Patients’ mean dose of prednisone was recorded at baseline prior to treatment and at 6 months and 12 months of treatment. The Leicester Cough Questionnaire scores and pulmonary function data were recorded at 6 months and 12 months of treatment.

Researchers noted prednisone mean dose prior to treatment was 16 mg and at 12 months dropped to 1 mg. They found improvement in the mean FEV₁ from 68.5% at 6 months to 75.3% at 12 months. In the same time frame, FVC changed but all within the normal range, from 80.7% to 85.5%. Researchers also observed a statistically significant improvement in the mean Leicester Cough Questionnaire scores from 10.0 at 6 months to 17.3 at 12 months.

Study limitations include lack of control group, lack of randomization, underpowered sample size, lack of measurement of pulmonary function and cough questionnaire data at baseline, and the disproportionate number of women vs men with Sjogren’s Syndrome.

The study author concluded that “Use of ICS and LABA for treatment of bronchiolitis in primary [Sjogren’s Syndrome] should be considered for reducing the need for systemic corticosteroids, [and for] symptomatic relief of cough.” Noting the associated improvements of FVC and FEV₁ over the treatment course, they added that “Systemic corticosteroids are associated with various side effects; hence, use of ICS-LABA should be considered in patients with [Sjogren’s Syndrome] and bronchiolitis for weaning of systemic steroids and for relief from debilitating cough.”

Reference

Tharwana A, Deshwal H, Parambil J. Use of inhaled corticosteriods/long-acting beta agonist (ICS-LABA) in patients with bronchiolitis caused by sjogren syndrome decreases need for oral steroids. Presented at: CHEST 2022 Annual Meeting; October 16-19, 2022; Nashville, TN. Abstract Poster 64A.