In a recently published case report, the importance of considering low risk treatment options in patients with multiple chronic diseases was highlighted after symptom remission was attained in a 45-year-old female patient suffering from “recurrent respiratory infections, asthma, allergies and atopic dermatitis since childhood and multiple autoimmune and chronic respiratory conditions as an adult” after immunotherapy was combined with daily high-dose guaifenesin.
According to the report, the patient complained of a non-productive cough, accumulation of mucus, and post-nasal drip and requested a thorough assessment of her medical conditions. Her history was significant for atopic dermatitis, medication and food allergies, allergic rhinitis, moderate-to-severe asthma, stable chronic bronchitis (6-8 exacerbations/year), recurrent pneumonia, viral pleurisy (one 11-month episode reported recently), chronic sinusitis with nasal polyps, celiac disease, inflammatory bowel syndrome, and Raynaud’s syndrome.
The patient’s medications included omalizumab administered monthly, allergy immunizations (pollens, molds, dust mites), montelukast daily, azelastine nasal spray, cetirizine, acetaminophen 325mg/guaifenesin 200mg/phenylephrine 5mg, and a proprietary isotonic saline nasal rinse every other day. The patient also reported the use of a levalbuterol inhaler in the past.
Following examination, the patient was directed to initiate guaifenesin 600mg twice daily to aid in expectorating the thick mucus she felt in the back of her throat. “Since starting the higher dose of guaifenesin, she reports that post nasal drip is significantly reduced, her cough is improved and mucus is much less viscous and easier to expectorate,” the study authors stated. The patient also reported that she did not experience any additional sinus infections and that her nasal congestion was significantly reduced. The authors added that the patient has since “been able to discontinue allergy shots and omalizumab with no relapse and perceived significant improvement in quality of life.” No treatment-related side effects were reported by the patient.
By presenting this case report, the authors demonstrate the importance of exploring all therapeutic treatment options, including over-the-counter and low-risk medications, in patients with multiple chronic conditions.
Lanier BQ, Miller J. Successful long-term, adjunctive use of guaifenesin in a patient with a complex atopic medical history and primary immune deficiency: A case report. Respiratory Medicine Case Reports. doi: 10.1016/j.rmcr.2018.08.011.