Atorvastatin as an anti inflammatory in bronchiectasis

Abstract

Background: Bronchiectasis is characterized by chronic cough, sputum production, and recurrent chest infections. Pathogenesis shows excessive neutrophilic airway inflammation is seen. Evidence suggests that statins could be a potential anti-inflammatory treatment in bronchiectasis. We did a proof-of-concept randomized controlled trial to establish if atorvastatin could reduce exacerbations in patients with bronchiectasis. Methods: Patients aged 18-79 years were recruited from the Royal Infirmary of Edinburgh. Participants had clinically significant bronchiectasis confirmed by chest CT and two or more chest infections in the preceding year. Individuals were randomly allocated to receive either atorvastatin (80 mg) or a placebo, orally once a day for 6m (months). Primary endpoint was reduction in cough from baseline to 6months, measured by the Leicester Cough Questionnaire (LCQ) score. A post hoc analysis of the pre and post exacerbations during the study was done. Findings: 30 individuals were assigned atorvastatin and 30 were allocated placebo. There was evidence of a significant improvement in baseline to 6-month change in LCQ in the statin treated group, with a mean difference 2.2, 95% CI for difference (0.5, 3.9) p=0.01. There was no significant difference in exacerbations comparing both groups during treatment. 21% patients on statin had ³3 exacerbations compared to 34% in the placebo group (RR 0.6, 0.2-1.5). Comparing exacerbations for the 6m pre study to the 6m on treatment, there was a significant reduction in the exacerbation frequency (*p=0.001) in the statin treated group. Conclusion: Post-hoc analysis of the study showed that statin treated patients had fewer exacerbations while on statins. Larger studies are needed.