Sialorrhoea treated with inhaled glycopyrronium

Our plain-English summary of Sialorrhoea treated with inhaled glycopyrronium, by C. Plunkett (BMJ Supportive & Palliative Care, 2021).

The study

• Author: C. Plunkett
• Journal: BMJ Supportive & Palliative Care
• Published: 2021;11(4):406-407
• Type of article: Case report
• Read it: PubMed · Publisher

Abstract

Sialorrhoea or drooling is a distressing and often socially isolating symptom seen in palliative care. Evidence to support efficacy and safety of drug therapy in sialorrhoea is limited. Most drugs, in an adult population, are unlicensed for this indication in the UK including glycopyrronium. A 73-year-old Caucasian man, diagnosed with a right-sided sarcomatoid malignant pleural mesothelioma, presented with difficulty in swallowing and sialorrhoea. A glycopyrronium inhaler (administering 55 μg of glycopyrronium bromide/puff) was initiated in the mornings, increasing up to three times per day as tolerated. He reported a significant decrease in his symptoms 2 days after initiation using a numerical rating scale. A regular dose of one puff two times per day completely resolved the patient's symptoms within 5 days. This case supports the use of inhaled glycopyrronium as a possible therapy for sialorrhoea in palliative care patients. In addition, doses required for resolution of symptoms were significantly lower when compared with systemic dosages.

© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.

In plain English

This case report describes one patient. A 73-year-old man with a right-sided sarcomatoid malignant pleural mesothelioma, who had declined all cancer treatment, developed drooling (sialorrhoea) that caused skin breakdown and sores. He tried a glycopyrronium inhaler, starting at one 55 μg puff once a day. Within 2 days his drooling score on a numerical rating scale out of 10 fell from 8 to 3. After the dose was raised to one puff twice a day, the score improved to 1 out of 10. The improvement lasted until his death 10 days later, and he reported no side effects. The author noted that the starting dose was twice the licensed dose for chronic obstructive pulmonary disease but lower than recommended doses for oral or injected glycopyrronium. The author concluded that the case supports inhaled glycopyrronium as a possible therapy for drooling in palliative care patients. As a single case, it describes one person's experience, not how often the treatment works. The article does not discuss asbestos exposure.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (one patient)
• Who was studied: One 73-year-old man with right-sided sarcomatoid malignant pleural mesothelioma, cared for by a specialist palliative care community team in the UK, who had declined all oncological treatment and developed drooling with skin breakdown
• Exposure: Treatment studied: a glycopyrronium inhaler, 55 μg per puff, starting at one puff once a day for 3 days, with increases up to three times a day as needed. Asbestos exposure is not described.
• Main results:
  • Within 2 days, at one 55 μg puff once a day, the patient's drooling score on a numerical rating scale fell from 8/10 to 3/10
  • After an increase to one puff (55 μg) twice a day, the patient's score improved further to 1/10
  • The improvement lasted until the patient's death 10 days later, and he reported no side effects
  • The starting dose that brought significant improvement was twice the licensed dose for chronic obstructive pulmonary disease, but lower than recommended oral or subcutaneous glycopyrronium doses
• The authors' conclusion: The author concluded that this case supports inhaled glycopyrronium as a possible therapy for sialorrhoea in palliative care patients

Topics

Medical terms in this study, explained in our Lexicon: Palliative Care, Sarcomatoid, Pleural Mesothelioma.

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