Transdermal Application of Steroid to Cervical Trachea for the Cough in Patients with Bronchial Asthma and Cough Variant Asthma-A Pilot Study

Abstract

Background: The delivery of steroid to asthmatic patients has been limited to inhalation therapy or systemic therapy. The objective of this study was to evaluate the efficacy of transcutaneous application of steroid over the cervical trachea to asthmatic patients as an alternative route of drug delivery. Methods: Five patients with bronchial asthma (BA), 10 patients with cough-variant asthma (CVA) and 13 patients with cough predominant asthma (CPA) whose symptoms were not adequately controlled despite their current therapy were enrolled in the study. Steroid ointment of mometasone furoate or betamethasone valerate, in the amount of 1/2 fingertip unit once or twice a day for up to 3 months, to the skin over the cervical trachea, was added to the current therapy. Diphenhydramine ointment was also tried by 14 of the study participants. Results: Out of 28 patients receiving the steroid treatment, cough was reduced in 11 patients (39.3%). Cough disappeared completely in 3 cases, improved in 7 cases, and reduced temporarily but worsened again during the course in 1 case. Out of 14 patients receiving diphenhydramine treatment, cough was reduced in 5 patients (35.7%). Conclusions: The existence of responders to topical steroid ointment therapy to the cervical trachea strongly suggests that the trachea is also involved as an airway inflammation site. Though less effective compared to inhaled corticosteroid therapy, the transdermal administration could be regarded as the third route of steroid therapy for asthmatic cough.